4 Things Staff-Challenged Hospitals Should Know about Tablo
Innovative in-house dialysis care models are helping to reduce burden and empower nephrology nursing staff.
The pandemic has intensified an issue that existed long before COVID became a household word: nursing workforce challenges. According to a May 2022 analysis by McKinsey and Company, by 2025, a decreased supply of the absolute RN workforce will be a key challenge to effectively meeting patient care needs. One of several key opportunities that the paper’s authors identify to address this formidable problem is innovating care delivery models to reduce burden on nurses. “The goal of innovation is to improve patient engagement and outcomes while allowing nurses to focus their care on those who need their help most,” say the authors.
The direly needed transformation they describe is already in play, in an unexpected and long-stagnant field: acute dialysis care. Kidney failure requiring dialysis is a complex and growing sector of healthcare, that for many years has required specialized and expensive infrastructure to provide life-preserving treatment to patients, including a reliance on resource-intensive dialysis machines and costly outsourced service providers.
For the first time in decades, acute care providers are now empowering their dialysis and ICU nursing teams, leading to many benefits and improved efficiencies including a positive, patient-centered dialysis experience and cost savings. But how?
They have all converted to in-house dialysis care models, with the Tablo® Hemodialysis System. Here are four things that staff-challenged dialysis programs should know about Tablo, based on the real-world experiences of hospital and dialysis team leadership.
#1: Fast training enables immediate workflow impact
According to a recent roundtable of front-line nephrology nurse leaders, the ease of use of Tablo and its step-by-step touchscreen interface enabled their programs to quickly and easily train nurses working in any care setting who were new to dialysis. The participants found that nurses working in any care setting can be trained to confidently and successfully perform dialysis care with Tablo.
In another example, St. Mark’s Hospital in Salt Lake City, UT, part of HCA Healthcare Mountain Division, made the strategic decision in March 2020 to revamp its inefficient outsourced dialysis model. The team set up a fleet of Tablo consoles and conducted a single four-hour training session with more than 20 ICU, floor and HD nurses. Immediately after training and realizing the technology’s ease of use, the nursing staff went live with sustained low efficiency dialysis (SLED) treatments on Tablo.
#2: Tablo-trained nurses ease in-house program launches and expansions
Throughout the extensive CHRISTUS Health system, multiple outsourced dialysis programs have converted to an in-house Tablo model over the past year and a half, using an efficient training strategy.
“For each implementation, we take an experienced nurse leader or director hired for the insourced program and send them over to a Tablo dialysis unit that is already running, so they can observe practices and really learn from how that structure is built,” says Krysta Myers, MHA, BSN, RN, Dialysis Program Director. “They then bring that training and workflow model back and duplicate it … from there, with Tablo, it’s very easy to learn and manage.”
At Catholic Health in western New York, the system’s two largest centers, Mercy Hospital of Buffalo and Sisters of Charity Hospital, became the first in the region in September 2021 to convert from a costly outsourced model to an in-house Tablo program. Two additional facilities then trained their nurses and launched their dialysis programs quickly and confidently, with support from nurses at the first two implementation sites.
“We have been able to incorporate a lot of super-user ICU nurses to assist in the dialysis unit as needed,” says Executive Vice President and Chief Business Development Officer, Joyce Markiewicz, RN, BSN, MBA, CHCE. “We were also able to find agency nurses to help with our nursing shortage who had used Tablo at other facilities, which was very valuable. Their skillset bought us some time so that we could train our own workforce.”
#3: Empower ICU staff with new skills
At Covenant HealthCare in Michigan, renal replacement therapy was dominating the hospital’s already-strained ICU nursing resources, and the outsourced provider was leading to delays in care and high treatment costs. When leadership made the decision to convert to Tablo, the ICU team was excited to learn the technology.
“It gives our nurses the ability to take ownership of the whole process,” says Toni Yursco, RN, ICU/Hemodialysis Nurse Manager. “We now have the ability to set that patient up right away. We don’t have to deal with uncontrollable delays in getting a machine or the supplies to the bedside. And, they were excited to learn something new and take on a new process, which isn’t always the way that things go.”
“The old system of outsourcing these services was not working well for us,” adds Senthil Ramaiyah, MD, who oversees Covenant’s dialysis program. “Patient care is being affected. Tablo has changed the game. Our Tablo program has led to an efficient use of resources in our ICU.”
#4: Flexibility with longer-duration treatments helps alleviate staffing challenges
The versatility of Tablo to provide Adaptive Dialysis—a term used to describe the system’s unique ability to span a wide spectrum of renal replacement therapy modalities up to 24 hours daily—is having a positive impact on ICU staffing.
“The ability to run shorter [<24-hour] treatments on Tablo allows us to achieve the same clearance results and alleviates some staffing concerns,” says Yursco. “We can run those 1:1 treatments on day shift if that’s where our staffing is, or move treatments to the night shift if needed. That has been very accommodating.”
At Providence St. Joseph Hospital in CA, the Tablo system’s versatility proved invaluable during the height of COVID patient surges in 2020. Karlo Pajaro, BSN, RN, Clinical Nurse Manager of the Renal Center and his team developed an efficient plan to treat patients with prolonged intermittent renal replacement therapy (PIRRT) or SLED, using Tablo XT machines. They designated one dialysis nurse a day to the ICU, to prime and set up all the consoles and start each patient’s treatment. ICU nurses then monitored patients during their 6 to 8-hour dialysis. The dialysis nurse would then conclude the treatments and prepare the machines for the next set of patients.
This strategy had an immediate positive impact on the team’s workflow. “When we started using Tablo XT for long-duration therapy, I only had to send one nurse to the ICU to set up and finish treatment for all 10 patients. So, I saved 9 RNs. Tablo has really been a game-changer for us. It really solved our staffing issue, and the machine and treatment issues we were having,” says Pajaro.
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For safety and effectiveness information, indications for use, risks, cautions and warnings, please refer to the product labeling for the Tablo Hemodialysis System.