4 Things Every Dialysis Nurse Manager Can Relate To

Summary

We asked a roundtable of seasoned dialysis nurse leaders to weigh in on the biggest challenges they face in acute dialysis delivery. They were able to solve them—here’s how they did it.

Acute dialysis care finds itself at the convergence of two formidable forces: an expanding and increasingly costly patient population and building momentum to finally implement real change in a resource-constrained specialty that has gone decades without innovation. We asked a roundtable of front-line nurse leaders from across the U.S., representing over 100 years of combined clinical and management experience, about how they’ve managed to carve successes out of these significant challenges.

Their top 4 issues—cost, complexity, capacity and clinical—echo the real-world experience of dialysis programs across the country. Their victories have come since insourcing the Tablo Hemodialysis System at their facilities.

Challenge #1: We Need To Control Our Costs!

“In our study, we saw a net savings projection of $450,000 in the first year of our in-house conversion to Tablo.”

– Kasadi Moore, MSNI, Division Director of Dialysis
HCA Mountain Division, Salt Lake City, UT

Our nurse leaders are proof that dreams can come true: dialysis programs can get a handle on notoriously exorbitant third-party vendor fees, the resources needed to manage water treatment rooms and portable RO units, and the need for a multitude of complex and cumbersome dialysis machines to provide treatment to their patients.

3 big wins after converting to an in-house dialysis program:

Eliminated the need for burdensome dialysis infrastructure such as water treatment and bagged dialysate solution, as the system requires only an electrical outlet and tap water to operate
Standardized renal replacement therapy onto a single technology platform that can deliver a wide range of therapies
Gained the ability to provide timely bedside dialysis in the acute setting

Challenge #2: Dialysis Care Has Become So Complex!

“Since we’ve brought our dialysis in-house with Tablo, our staff is much more collaborative and efficient. We’ve been able to build a strong program, and focus on our patients instead of problems.”

– Christy Waldo, RN, Dialysis Nurse and Program Leader
Landmark Hospital of Joplin, Joplin, MO

As most every dialysis nurse leader who works with an outsourced dialysis provider knows, complexity and lack of control are commonplace. Being reliant on an outside vendor for all dialysis-related staff, treatment setup and takedown, and machine troubleshooting and maintenance leads to delays and frustration for nephrologists, nurses and patients. But yet, these complexities are solvable and dialysis programs really can run smoothly and efficiently.

3 big wins after converting to an in-house dialysis program:

Quickly and easily trained in-house nurses who were new to dialysis, which allowed them to standardize their dialysis equipment while establishing and maintaining high levels of competency
Gained the flexibility to treat anywhere within the acute setting
Reduced the amount of equipment they need to transport down to one compact machine

Challenge #3: We Simply Don’t Have The Nursing Capacity!

“I trained my three traveler nurses on Tablo in just a few hours, because of the simplicity of the machine and its ease of use. With other machines it takes at least six weeks to feel comfortable. With Tablo, I train them and they’re off! That’s a really big plus.”

– Faith Lynch, MSN, RN, CNN, Acute Dialysis Nurse Manager
NYU Langone Hospital Long Island, NY

Nursing staff shortages and capacity is a serious issue across healthcare, not only in nephrology. For our roundtable participants, their outsourced dialysis departments suffered from inefficiency as staff competency was spread amongst several different complex machines and departments, and frequent outsourced staff changes and turnover led to a poor continuity of care.

3 big wins after converting to an in-house dialysis program:

Any nurse working in any care setting can be trained to confidently and successfully perform dialysis care with Tablo

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The four-hour training period with Tablo reduced the time that nurses had to spend in addition to patient care to develop the skill of providing dialysis
Gained the ability to accommodate different patient-to-staff ratios as allowed or needed (especially critical during COVID surges)

Challenge #4: Our Clinical Care Is Being Impacted!

“Since going insource with Tablo, this is the first time in a long time that we’ve had control of our quality management.”

– James Eric Simmermon RN, MSN, Corporate Clinical Implementation Specialist
HCA-Healthtrust, Panama City, FL

Our roundtable described an array of troubling issues with outsourced programs, including delays in providing emergent treatment during off hours and weekends, treatment change and prescription issues, the inability to expand dialysis offerings beyond CRRT and IHD, and the struggle to coordinate insourced ICU RNs, outsourced HD RNs, pharmacy and biomedical engineering staff. These issues led to their in-house nursing team having a limited ability to impact overall patient care quality, resulting in lower team efficacy and morale.

3 big wins after converting to an in-house dialysis program:

Flexibility to deliver a range of treatment modalities, durations and flow rates, allowing for broad clinical applications
Simplified disposable, single-use Tablo cartridge with pre-strung bloodlines and compatibility with any dialyzer helps reduce setup time
Seamless ability to adjust therapy mid-treatment (time, modality, concentrate, etc.) without having to end treatment or needlessly waste supplies