Decatur Morgan Hospital: A Dialysis Program Ready for Action in Hard-Hit Alabama
Alabama is being hit hard by COVID, but the team at Decatur Morgan is prepared to help its community by utilizing the strength of its in-house dialysis program with Tablo.
Southern states make up the top 10 list of those hardest hit in the U.S. by kidney failure, and Alabama ranks number one in the nation per capita for kidney dialysis patients, according to the Alabama Kidney Foundation. The state also currently has one of the lowest COVID-19 vaccination rates and a high level of community transmission. This is compounded by a high rate of diabetes, the leading cause of kidney disease, as well as obesity and physical inactivity.
Decatur Morgan Hospital, a small, 24-ICU-bed community hospital in Morgan County, Alabama, is in the thick of this end-stage kidney disease (ESKD) and COVID hotspot, and is once again seeing a spike in novel coronavirus patients. As of August 24, its ICU beds are full. In 2018, the hospital was the first in its network to bring the Tablo Hemodialysis System in-house and due to its positive experience, including during COVID this past winter, at least three other hospitals in the Huntsville Health System have followed its example. Decatur’s nephrologist, Reginald Gladish, MD, and Dialysis Nurse Manager, Kerri Roy, MBA, BSN, RN, are feeling prepared if they need to go into COVID crisis mode yet again, with a fleet of Tablo consoles and well-trained staff throughout the hospital.
“Tablo, with its simplicity, is able to take away some of the technical aspects of running the treatments, to allow our dialysis nurses to focus on the clinical aspects of the treatment and the patients’ condition,” says Gladish.
Hospital administration was interested in Tablo as they saw an opportunity to provide dialysis services at a lower cost—and not only at Decatur, but also at other hospitals across the network in north Alabama and southern Tennessee. “The teams across our network thought that by first converting our dialysis program to an in-house Tablo model, they could see how well it worked for us, and then other hospitals that were currently outsourcing dialysis could convert as well,” says Gladish. “We’ve been using our fleet of Tablo systems successfully for two years now, and now our largest flagship hospital, Huntsville, has brought in Tablo, along with Athens Hospital and Marshall Medical. The latter didn’t have dialysis services at all, until Tablo. This will benefit them as they won’t have to transport patients for in-center treatment.”
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Roy, a nurse for eight years, took on the role of starting up Decatur’s in-house Tablo dialysis program in July 2019. “It was a big task, but I received a lot of support from Dr. Gladish, my medical director, our admin team, and nurse leaders from other hospitals across the country. In the acute setting, patients are a lot sicker, and you have patients coming into the ER, so there are a lot of moving parts.” She now has four full-time RNs. She agrees with Gladish that they are definitely more prepared now that COVID is ramping up again. “We have all our hemodialysis products ready, and the Outset Medical team has been so helpful.”
Roy agrees with Gladish that a network-wide strategy will be of benefit to all, especially due to COVID. “Since other hospitals within our system have brought on Tablo, we have more options if we need to borrow supplies. It also helped with cross-training in our network. Our past pandemic experience definitely took off a lot of blinders, so although we are constantly learning, we feel confident with Tablo that we are prepared, across our network. We could not have done this with any other machine,” she says.
“The Tablo system’s ease of training and use, along with support from Outset Medical, has been key to our success. We’re using this time now to grow our pool of trained nurses, including from the ER, ICU and floor, so that we’re ready to dialyze in a more flexible way.” – Reginald Gladish, MD
A COVID-Ready Team
In Decatur’s ICU, the team uses sustained low efficiency dialysis (SLED) as their primary modality when treating patients needing dialysis, including during the COVID outbreak that they had in December and January, and Gladish says he is very comfortable ordering it. “The simplicity of the Tablo graphic user interface really sets it apart from other machines. Tablo really performs well. It has allowed us to do more SLED, with treatments generally running for about 8 hours. From a dialysis standpoint, I feel that’s more than enough.” (Dr. Gladish is a co-author on this SLED Therapy Update paper published in the April 2021 issue of Nephrology Times.)
“From experience we know that we are able to safely and effectively deliver treatment with Tablo in the ICU, and can group COVID patients for bedside dialysis as needed, while minimizing exposure around the hospital,” he says. “Also we were short-staffed. There for a while, we were down about 100 employees at our hospital. “The Tablo system’s ease of training and use, along with support from Outset Medical, has been key to our success. We’re using this time now to grow our pool of trained nurses, including from the ER, ICU and floor, so that we’re ready to dialyze in a more flexible way. We can also easily transport Tablo to deliver care in any area of the hospital.”
“There are so many aspects of the machine that enable you to safely care for patients in highly stressful situations. I didn’t realize until we were in the middle of our pandemic surge how much this machine would really help us. We were able to dialyze patients and didn’t miss a beat. I am forever grateful for the phenomenal support of our Outset team, even two years later, and for Tablo,” adds Roy.
Gladish explains also that their efficiency has been further impacted by the system’s remote patient monitoring feature. “This capability wasn’t possible with our past devices. This will be critical as the home dialysis opportunity with Tablo expands.” Roy says that remote monitoring is her favorite Tablo feature. “Although our ICU nurses are empowered by being able to run treatments on Tablo, we help monitor any dialysis patients that are there, as they’re still ultimately our patient. It helps provide overall ease for the staff, and that makes everyone feel that we’re taking the best care of our patients that we can.”
Decatur Morgan Hospital
Decatur Morgan Hospital is an award-winning, community hospital serving Morgan County, Alabama. An affiliate of the Huntsville Health System, Decatur Morgan provides innovative medical care at four locations. More than 200 physicians of various specialties make up our medical staff, providing outstanding care to our community. As one of the largest employers in the county, our nurses, clinicians, technicians, and support staff comprise a team of more than 1,300 professionals dedicated to Morgan County.
The Tablo® Hemodialysis System is indicated for use in patients with acute and/or chronic renal failure, with or without ultrafiltration, in an acute or chronic care facility. Treatments must be administered under physician’s prescription and observed by a trained individual who is considered competent in the use of the device. The Tablo Hemodialysis System is also indicated for use in the home. Treatment types available include Intermittent Hemodialysis (IHD), Sustained Low Efficiency Dialysis (SLED/ SLEDD), Prolonged Intermittent Renal Replacement Therapy (PIRRT), and Isolated Ultrafiltration.
This device is not indicated for continuous renal replacement therapy (CRRT) and is cleared for use for up to 24 hours. The dialysate generated by this device is not sterile and should not be used for intravenous (IV) infusion.
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