AdventHealth Ocala: A Role Model for Patient-Focused Dialysis Care with Tablo
The hospital, located in a Sunshine State dialysis hotspot, converted to an insourced Tablo program last June, modeled after successful programs at sister facilities. Having exceeded all expectations, Ocala is adding more staff and rethinking its nursing resource strategies.
AdventHealth Ocala is a 425-bed acute care community hospital in Ocala, FL—a region with some of the highest dialysis rates in the state. The facility became part of the AdventHealth network in late 2018, and at that time, its VP and CNO, and past critical care nurse Patricia Price, along with other leadership, began looking to overhaul the campus’ outsourced, resource-intensive, cumbersome and costly dialysis program. They decided to strategically align Ocala’s program with the in-house, all-Tablo programs that were running successfully at other AdventHealth campuses.
“Our decision to convert Ocala to an in-house model was based on research looking into the most efficient, high-quality, cost-effective equipment available that could replace our previous outsourced machines. Tablo was selected based on its ability—demonstrated at our sister campuses—to safely and efficiently dialyze patients, and its superior performance and positive patient outcomes,” Price says. Sealing the deal were the overwhelming surges in COVID-19 dialysis cases coming through the hospital’s ER and ICU, which underscored the inefficiencies of existing equipment and the urgent need for an innovative solution.
Nearly a year after its launch, AdventHealth Ocala’s in-house Tablo dialysis program is now a role model for other campuses, both within and outside of the West Florida division. The hospital’s success has been driven by efficient training across a diverse nursing team, high patient, nurse and nephrologist satisfaction, proven benefits during the pandemic, and expectations-exceeding treatment volumes.
A Diverse Team Built Upon Sister Campus Success and Ease of Use
Price tasked then-inpatient nursing leader, Tricia Allen, BSN, RN, CNML, with the training and implementation effort at Ocala. Allen, who has nearly 30 years of nursing leadership experience in specialties outside of dialysis, worked with the Outset Medical team to train and gain experience on Tablo over a four-week period at the neighboring Altamonte Springs campus. That facility has had a successful insourced Tablo program in place for more than two years. Allen, now the Assistant Nurse Manager, Acute Dialysis Services, also trained her team of full-time dialysis nurses, along with PRN/pool, med surg and ICU nurses on Tablo at AdventHealth’s Altamonte and Apopka campuses.
“I jumped at the chance to start our program from the ground up and really make it our own,” says Allen. “It was an amazing experience for us to train with and learn from the nurses at other campuses—we were able to see their day-to-day workflow with Tablo. We were able to build our program around their experiences. Utilizing those campuses as a model was invaluable.”
Allen’s staff, who have previous experience with dialysis, noted that training on Tablo was much easier and faster, compared to other machines they have used in the past. They were able to spend as little as two weeks on training—in contrast to 8 to 12 weeks on other machines. Afterward, they felt very comfortable in setting up and performing treatments.
“Tablo’s touchscreen is just like using your cell phone or tablet. The ease of use and step-by-step on-screen directions have been some of the biggest benefits of Tablo,” says Allen. “This has allowed my nurses to spend more time focused on the patient. That’s where I’ve seen a huge impact, as that’s where our focus really should be,” she says.
Patient, Nurse and Nephrologist Satisfaction
In June 2020, working closely with the Outset Medical team, AdventHealth Ocala converted their eight-bed dialysis unit to a fleet of Tablo consoles, and added the devices to other hospital departments. The hospital’s Tablo program began to make an impressive impact right away.
“Many of our long-time ESRD dialysis patients said that they were thrilled with the new Tablo machines, the quietness of them with fewer alarms, and that they were able to rest during their treatment,” says Allen. “They also commented on how much better they felt after their treatments compared to other machines, including less cramping. It was a very positive experience, right from the get-go.”
Allen notes that the Ocala team uses Tablo’s full range of treatment modalities, including IHD, SLED, isolated UF, sequential therapy (enables a seamless transition between HD to UF or UF to HD), and Extended Therapy (XT; enables up to 24 hours of continuous therapy at a minimum Qd of 50 mL/min) in place of continuous renal replacement therapy (CRRT) that they used with previous machines.
Tablo’s versatility, easy treatment management and maintenance, as well as its compact size and portability, have been hugely beneficial to the Ocala team, according to Allen. “Whichever modality we need, we have Tablo consoles available at our fingertips that can be moved into the dialysis room or wherever they are needed, and treatment is started quickly and easily,” she continues.
Price says that the move to Tablo also helped improve the nursing team’s relationship with their nephrologists. “We’ve been working to build credibility with our nephrologists in town. When they found out we were moving to Tablo, they couldn’t believe it. All of them knew what type of equipment that was and what a difference it would make for our dialysis patients,” says Price.
“All of our nephrologists have really been happy with the outcomes for their patients who are receiving treatment on Tablo,” she says. “The benefit with Tablo versus traditional continuous treatments is that there can be time during the day where they are ‘dialysis free,’ and able to go to procedures or have tests done. This has also aided in our staffing and workflow. And importantly, we’re seeing the same outcomes for those patients,” she continues.
“All of our nephrologists have really been happy with the outcomes for their patients who are receiving treatment on Tablo.”
– Patricia Price, DNP, RN, NE-BC
Allen notes that Tablo’s capabilities have led to other unexpected staffing benefits. “In the past, with complicated CRRT machines, only a small group of ICU nurses knew how to use that modality. What we have discovered is that now because Tablo is simple and easy to train and use across a variety of modalities, there are a greater number of nurses on staff who have the expertise. If one of the ICU nurses needs assistance with a treatment, my dialysis nurses can support them,” Allen says. “That has been a huge benefit for our campus, for patient care, and the efficiency of our staff. Along with that, our ICU nurses are now so proud to say that they can do dialysis, as they didn’t think that was a skill set they’d ever be able to learn. It has really made me happy to help them grow.”
COVID-19: A True Pressure Test
In addition to their day-to-day dialysis caseloads, the monumental challenges presented by COVID-19 also helped to prove out Tablo’s indispensability in Ocala’s ICU, Price emphasized. “We saw patient numbers that were unbelievable. During the COVID surge, it was not uncommon that we were dialyzing almost every patient in the ICU, including those who did not have kidney failure prior to contracting the virus. Historically, with previous machines, we would have patients treating for 24 hours, with a constant 1:1 nurse-to-patient ratio. With Tablo, treatment modalities and times are adjustable depending on the needs of each patient, while maintaining high quality. We were able to partner with Tricia [Allen] and her team to make sure all our patients received care, and reduce the nurses’ COVID exposure. Tablo was truly a lifesaver for us, as I can’t imagine if we would have had to handle the number of ICU patients we saw with any other dialysis machine,” says Price.
Price also notes that the benefits that they saw during the height of COVID are paying off longer term. “Because of Tablo’s comfort and ease of use learned through the lessons of this pandemic, we’re thinking big picture,” she says. “We’re looking to potentially adjust our dialysis practice in the ICU. There’s more to come on that.”
Allen reiterates the critical role that Tablo played during the pandemic, and a silver lining. “COVID did provide its challenges, but amongst so much negativity that we’ve had in the last year, I will say that because our Tablo program has been so successful, it has lifted the spirits of the staff at our campus. The C-suite was also very excited to see that we had such a successful launch, even during the tough times of the pandemic. To have a positive impact for the campus and our patients, it made us all feel really good,” she says.
In-House Conversion Strategy Pays Off
Price notes that from day one of converting to a full in-house program with Tablo, the Ocala campus has exceeded expectations. Due to this success, the dialysis nursing team is being expanded as the hospital prepares to meet the growing need for dialysis treatment in its community. “That’s a big deal and a win for us. Our projected treatment volume has been higher than originally projected, because of the success and efficiency of the machines, we have had to add staff. It’s been fairly easy to add staff because we have a large pool of traditional HD nurses and ICU/med surg nurses to choose from,” she says.
“From a financial standpoint, we’ve gained back everything that we had set out to do, and we continue to be a resource for the community. We get great feedback from the patients and physicians, and we have a lot of referrals that come through, so it’s really been a great strategy and initiative for us here at AdventHealth Ocala,” Price continues.
“My team is really flourishing, and we’re owning our dialysis services now. We’re proud to have this opportunity to have a positive impact on our patients as well as our staff,” adds Allen.
Price also notes that AdventHealth’s multi-campus training and implementation strategy would never have been considered using other dialysis machines. “The other machines we were using required a lot of dialysate solution, water treatment, and other costly resources that Tablo does not. We actually decreased our storage space, and even cleaned out an entire room, as the supplies that are required with Tablo are substantially less.”
She also emphasizes the role that the Outset Medical team played in their conversion and success. “It’s really been a great partnership,” she says. “I’ve felt that a lot of our mission, vision, and goals are aligned. It has really been an easy process for us to work together, and to ultimately help our patients. A lot of times you just don’t see that level of support from companies, but Outset has been fully dedicated to making our program successful.”
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ABOUT Adventhealth ocala
AdventHealth Ocala is a 425-bed full-service community hospital that opened in 1898. In August 2018, AdventHealth Ocala became a part of the AdventHealth network. The facility is 640,000 square feet and sits on 15 acres. Within the hospital network there are two 24/7 ER facilities, one onsite and another offsite, to better meet the needs of Marion County. The onsite ER has both an adult and children’s emergency department that has over 50 combined beds with the ability to treat many conditions and injuries. Established in 2002, the offsite ER, AdventHealth TimberRidge ER, is a 24-hour full-service emergency department with 16 private rooms and was the first offsite ER in the state of Florida. The hospital offers many inpatient services including, labor and delivery through The Baby Place®, Orthopedic unit, comprehensive cardiovascular surgery unit, and a wound care center. AdventHealth Ocala is accredited The Joint Commission and has received recognition from American Heart Association and American Stroke Association.
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Note: Results may vary. For safety and effectiveness information, indication for use, risks, cautions and warnings, please talk to your doctor and/or refer to the product labeling for the Tablo Hemodialysis System.