Proven Formula for Acute Dialysis Success Across the South
Having converted multiple outsourced dialysis programs to an in-house model with Tablo over the past year, CHRISTUS Health is achieving financial and quality gains, and confident, pandemic-prepared nursing teams.
The southern U.S. carries the burden of a large and rapidly growing end-stage renal disease (ESRD) population, along with a continuing influx of COVID-19 hospitalizations and associated acute kidney injury (AKI) cases. This summer, the South was also impacted more than other regions by the highly transmissible COVID Delta variant and low vaccination rates. The situation has put an unprecedented strain on hospital ERs, ICUs and dialysis units.
For the extensive CHRISTUS Health system, that includes more than 60 hospitals and many other healthcare facilities across the southern states of Texas, Arkansas, Louisiana and New Mexico, the high cost and ever-growing demand for dialysis called for some bold changes. Since last October, CHRISTUS has successfully converted many of its acute dialysis programs from outsourced third-party dialysis providers to an insourced model with the Tablo Hemodialysis System. Using a proven implementation and practice standardization model, these facilities are now, a year later, successfully treating patients requiring intermittent to Extended Therapy (XT) dialysis modalities with Tablo.
Dialysis Program Director Krysta Myers, MHA, BSN, RN, is overseeing the project. She describes why the decision was made by administration to move to an insourced dialysis model, following financial and quality management analyses that began in January 2020.
“We found that the level of quality oversight was lacking with our outsourced providers, and there were high extraneous costs such as extended length of stay, dialysis on day of discharge, and other problematic areas that we wanted to improve. We found that Tablo represented a beneficial new adaptive dialysis technology that we’ve needed for a long time,” says Myers. “A year in, I can say that it’s had a huge impact on our staffing and COVID response, in comparison to our previous machines.”
Ready, Set, Launch, Repeat
Last October, Myers led the first of a long list of Tablo in-house conversions at CHRISTUS St. Vincent in Santa Fe, New Mexico. This was followed in February of this year with CHRISTUS Southeast Texas in Beaumont, Texas. “Since their launches, our first two programs have been running very successfully, mostly using intermittent hemodialysis [IHD] in the dialysis units and ICU, all with Tablo,” she says.
Myers then managed Tablo implementations at CHRISTUS’ northeast Texas facilities earlier this year. She worked with Outset Medical to train nursing staff and start treating patients on a fleet of consoles at multiple hospitals within the Trinity Mother Frances and Good Shepherd Health Systems. Those facilities have larger dialysis programs than St. Vincent and Southeast Texas, and both also have a high COVID census. They had both formerly been performing continuous renal replacement therapy (CRRT) as a treatment modality, in addition to IHD.
“We also were able to eliminate NxStage and having to use the bagged dialysate, which we found as a huge positive for cost savings.”
“We converted those CRRT programs over to Tablo with Extended Therapy, which has been very successful,” she says. “The ICU and dialysis nurses were a little hesitant at first in moving forward with Tablo for those longer treatments. But, once they brought it in and were quickly trained to use it, they found that it worked very well and they’re happy with it—from a quality and workflow standpoint as well. When dialysis is outsourced, half the time your team doesn’t know what’s going on, there’s no control. That was something that we saw as another positive with Tablo. We also were able to eliminate NxStage and having to use the bagged dialysate, which we found as a huge positive for cost savings,” she continued.
Following those launches, Myers then managed conversions in San Antonio that went live with Tablo this March, including CHRISTUS Santa Rosa Health System, where Dialysis Medical Director Varshi Broumand, MD, FASN, practices. Dr. Broumand has played an integral role in creating the framework and policies for the new programs being implemented across the network. He’s also a nephrologist and interventional nephrologist at South Texas Renal Group, a large practice serving patients throughout San Antonio and south Texas.
“We insourced all four Santa Rosa facilities, essentially on the same project timeline. They also replaced their CRRT machines with Tablo with XT and had a very successful experience,” says Myers. “It’s been proven repeatedly that Tablo is working for us, and in both IHD and with Extended Therapy. All our teams have found that the machines are very easy to use, with the step-by-step touchscreen interface, and training was simple and straightforward. We’re very happy with the outcomes for our patients. Due to these successes, we are currently working on additional conversions in Texas and Louisiana.”
“From a doctor’s and staff standpoint, Tablo has truly helped us with our inpatient dialysis care, especially during this pandemic,” adds Dr. Broumand.
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He also notes that having Tablo in the acute setting has allowed for flexible, shorter dialysis treatments, allowing time to easily move patients to other rooms or services. “Our patient outcomes have also been very good, equivalent to what we were achieving on our previous machines,” he says.
“I have nothing but positive things to say about Tablo. It’s the best innovation in dialysis in the past 20 years,” he adds. “To other health systems that are considering offering dialysis services with Tablo, once your team is trained and feeling comfortable, you’re going to see tremendous benefit and overall satisfaction with your program. We are seeing that even during the pandemic, with our nursing teams stretched very thin.”
“I have nothing but positive things to say about Tablo. It’s the best innovation in dialysis in the past 20 years.”
Well-Led Programs Prepared for the Future
The successful Tablo implementations across the CHRISTUS Health system can be attributed to a proven practice standardization approach, along with having exceptional nursing leadership, Myers explains. “For each implementation, we take an experienced nurse leader or director hired for the insourced program and send them over to a dialysis unit that is already running, so they can observe practices and really learn from how that structure is built. They then bring that training and workflow model back and duplicate it,” she says. “It’s very important to have a nurse leader who can help lead the project, understand the action items that are needed to help successfully introduce internally run dialysis services, be strong in setting the overall tone and teach those practices to their teams. From there, with Tablo, it’s very easy to learn and manage. All of our programs are running smoothly and are of high quality.”
Internal cross-training has also been important across CHRISTUS’ hospitals, in light of COVID surges and worsening nursing shortages. “We have ICU nurses who are training on Tablo with the dialysis team so they are able to handle all aspects of treatment,” says Myers. “So, it is really instilling confidence in our ICU nurses and expanding their scope of responsibilities.”
Dr. Broumand also notes that his team’s experiences over the last 18 months of the pandemic have helped them to feel prepared for any situation that could occur going forward. “If you have experienced nurses, everything goes smoothly. The knowledge and experience that they bring to the table is very helpful.”
Myers agrees that their teams are ready in case of further COVID surges. “They’re building upon the plans that they implemented last year and coordinating with our nephrologists to implement even better plans this year, including with our surge that’s happening now,” she says.
About CHRISTUS Health
At CHRISTUS Health, we deliver a complete healing experience that respects the individual. We serve our communities with dignity. And with a good deal of admiration. CHRISTUS Health is a Catholic, not-for-profit system made up of more than 600 centers, including hospitals, urgent care centers, health insurance companies, ambulatory centers and physician clinics. We are a community of 45,000 Associates, with over 15,000 physicians providing individualized care—and all focused on our charitable mission.
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