31 Days to Independence for Deaconess Health with In-House Acute Dialysis
Three Deaconess Health hospitals in the IN-KY area quickly transitioned from a long-time outsourced provider to in-house acute dialysis with Tablo. Among the positive results: a 99% clinical success rate.
Imagine that an acute dialysis program, that provides life-sustaining intermittent hemodialysis (IHD) treatments to more than 5,000 patients a year across several facilities, is at a critical boiling point. Rising kidney disease patient census numbers, outsourced dialysis services costs and nursing staff challenges are significant issues. At the same time, the annual outsourced contract that is up for renewal in only 31 days offers no real solutions. Meet the Deaconess Health team, who dealt with exactly this scenario in late 2022.
From October through early November 2022, in close partnership with Outset Medical, the nationally recognized, not-for-profit Deaconess Health system succeeded in transitioning three hospitals in the IN-KY area from an outsourced IHD dialysis provider to an independent, in-house acute dialysis model with the Tablo® Hemodialysis System. This included 263-bed Deaconess Midtown Hospital in Evansville, IN, 259-bed Deaconess Gateway Hospital in Newburgh, IN, and 117-bed Deaconess Henderson Hospital in Henderson, KY, that together serve about a 51-county region. The coordinated, 31-day implementation was led by Cathy Murphy, MSN, RN, MHA, CCRN, System Director Joint Ventures, and Vascular & Renal Service Lines, and Dara Goodwin, MSN, RN, CMSRN, Service Line Manager of Renal Services.
Key elements in the success of this project included close collaboration between stakeholders at Deaconess Health and the Outset Medical team, and temporary nursing staff support from Outset’s Bridge Program. The Deaconess network has seen a 99% Tablo clinical success rate during the first six months of their new in-house dialysis program, faster staffing than expected, lower costs and improved patient outcomes.
Outsourced Dialysis Services Model at a Crossroads
For more than 10 years, the renal departments at Deaconess’ IN and KY hospitals had a strong relationship with an outsourced provider for contracted IHD services. But over the past two years, a multitude of hurdles including pandemic-induced nursing staff shortages and capacity issues with a growing kidney disease patient census had made outsourced dialysis services more problematic.
“We worked well together for a long time. But as everyone in healthcare knows, recently we’ve had to navigate some huge challenges,” says Murphy.
Deaconess had been experiencing operational, process and labor resource need challenges, creating financial changes. And, the annual contract was quickly coming up for renewal.
In August, Deaconess was made aware of changes to the upcoming contract. The health system would experience an increased fiscal burden in managing acute care patients requiring IHD.
Murphy and Goodwin, who together manage the dialysis programs at their three hospitals, were surprised by this development. They and other Deaconess leadership convened to address the issues with the impending contract. The Deaconess team made the decision to actively establish a different path forward.
“We did an extensive evaluation and asked ourselves if it would be better to create our own internal model of dialysis care, versus relying on contracted services,” says Murphy. “We found that our health system would be better served by having our own oversight and leadership over services for our renal patients, including hemodialysis.”
The decision to make the leap to standing up their own in-house acute dialysis program goes back to fulfilling the health system’s triple aim. “We follow the triple aim of, number one, improving the health of our patients in our community and being able to give them the satisfaction and the experience that anybody should have in healthcare,” says Murphy. “Second, we focus on our quality outcomes, and lastly, it is our responsibility to be fiscally responsible for the care that we provide.”
Murphy says that she, Goodwin and their other stakeholders discussed that if they moved forward with an in-house acute dialysis program, who would they want to partner with that could provide the equipment resources they needed and within their extremely tight timeframe?
Goodwin recalled a new technology she learned about at a nephrology tradeshow back in 2019, Tablo from Outset Medical. At the time, she and a colleague attended site visits with the Outset team, looking at the flexibility of the system in acute and chronic care settings, and really liked what they saw (note that in 2020, Tablo was also FDA-cleared for patient use in the home). At that time, however, Deaconess leadership decided to stay with the outsourced dialysis provider.
Fast-forward to 2022, and Tablo re-entered the conversation, from the positive impression that the company and technology had made on Goodwin four years before. Now with only 31 days until they would be without an IHD provider, the decision was made to bring Tablo in-house at all three Deaconess campuses in the IN-KY area: Midtown, Gateway and Henderson.
An implementation plan with the Outset Medical team was put into action immediately. Deaconess brought together an internal project management team and stakeholders including medical directors, nurse leaders, nephrologists, finance, purchasing, human resources and regulatory in the conversion effort. A fleet of Tablo consoles were brought in for each campus, based on the volume of hemodialysis in each community, with Midtown and Gateway being the largest programs. The number of machines was later almost doubled due to demand.
“We were very impressed with the team approach that Outset takes to ensuring customer trust and success, and that they view our relationship as a true partnership,” says Murphy. “The launch across our campuses was incredible, it was like a well-oiled machine. They listened to us, and we created a real synergy together. Outset helped reassure our entire team and gave us confidence that we would hit this hard deadline of going live in early November. They committed and delivered on implementing everything, which gave us so much trust and respect for the company, the team and also the product, Tablo. It truly made us feel that we could do anything as we were able to implement our in-house acute dialysis program and provide the very best care for our patients.”
We were very impressed with the team approach that Outset takes to ensuring customer trust and success, and that they view our relationship as a true partnership.” – Cathy Murphy
A Bridge to Staffing Success
In addition to hiring dialysis nursing staff for the new in-house program, the Deaconess team utilized another tool to help get the programs going quickly at all three facilities: Outset Medical’s Bridge Program. In the program, Outset expert dialysis nurses join a hospital’s staff for a period of 4-13 weeks to provide Tablo expertise, run and supervise patient treatments, help with hands-on skill training and help ensure nurses and nephrologists are comfortable with the new technology.
“The Bridge Program was exceptional. They delivered on what was promised and we are very appreciative of the two Outset nurses that we brought in,” says Goodwin. “As you can imagine under our tight deadline, everything was very fast paced, including Tablo training. We probably would not have been able to succeed without the support we had from Outset Medical.”
“The Bridge Program was exceptional. They delivered on what was promised and we are very appreciative of the two Outset nurses that we brought in.” – Dara Goodwin
Goodwin explains that while the Deaconess team was hiring and training nurses, the Bridge nurses helped with not only patient treatments until the new hires were confident in doing dialysis on the new machines, but also to review and help with treatments and answer any questions. “Incredibly, they also helped us change our dialysis staffing model to be more flexible and accommodate treatments 24 hours a day six days a week, with on-call staff on Sunday,” she says. “The physicians and nurses really embraced that model, as other patient treatments such as surgeries or physical therapy could be scheduled around their dialysis. We couldn’t easily do this when the service was outsourced.”
When Deaconess had enough staff hired in, the team pulled selected individuals into Outset’s advanced Tablo Coordinators Program, in which Deaconess staff members learn to mentor new hires through Tablo training and best practices.
In Murphy’s view, the Bridge Program exemplifies Outset Medical’s commitment to the partnership with Deaconess, and was a critical component in the smooth and rapid transition to an in-house acute dialysis program with Tablo. She offers advice to other dialysis teams as well.
“We probably should’ve decided sooner about bringing the Outset Bridge nurses in, and kept them longer, because their skill and expertise truly supported our program,” she says. “Lessons learned there for others considering an in-house program would be to really consider the Bridge Program upfront. It’s well worth it because your program gets the clinical treatment support you need. The Bridge nurses really know their stuff, not only providing patient care but also training, coaching and educating your team along the way,” she continues.
Murphy notes that the Bridge nurses also helped tremendously with getting nephrologists on board with the new technology. “Outset’s Bridge nurses listened to the concerns of our nephrologists, and their expert knowledge of the machine, prescription orders and clinical evidence really helped the physicians become much more comfortable. They had been dealing with a third-party provider and prescribing on other less user-friendly machines for so many years,” says Goodwin. “Now, several months out from our go-live, I’m not hearing any issues from our nephrologists.”
For Goodwin, the biggest and most significant impact of the transition to in-house acute dialysis with Tablo is independence and the ability to grow their program. “When we were with the third-party provider, we were limited in so many ways,” she says. “Tablo has really opened everything up for us, and we’ve grown our IHD program. Tablo has allowed us to become independent, where we can make our own decisions and move forward where we want to be. We wish we would have gone with Outset back in 2019.”
Murphy also says that clinical success with Tablo has been excellent. “We have a 99% clinical treatment success rate. That’s a huge difference for us compared to our experience with outsourced dialysis services. The successes we’ve had paralleled the triple aim goals that we have as an organization. If you keep the patient at the center of everything you do, you will find that you’ll do the right thing, and at the right time. That’s what we saw with Outset’s philosophy and approach, that matched Deaconess’ strategy.”
She also notes that phase two of their Tablo implementation will help optimize their organization’s clinical, regulatory and quality data by integrating the digital connectivity capabilities of Tablo with their Epic EHR [electronic health records] system. (Deaconess CareConnect EHR utilizing Epic is the most fully featured, completely integrated system in the region.) “We are also looking at adding Tablo to our ICU, and are also envisioning post-acute and home hemodialysis and what that could mean for our hospitals and patients in our communities,” says Murphy. “We feel very confident about our dialysis services now because of the relationship that we developed with the Outset team, and the successful implementation that we accomplished across our campuses.”
ABOUT DEACONESS HOSPITAL
Deaconess Health System is the premier provider of health care services to 51 counties in three states (IN, IL and KY). The system consists of 20 wholly owned, joint ventured, sponsored or affiliated hospitals located in southern Indiana, southeastern Illinois and western Kentucky.
Deaconess Clinic, a fully integrated multispecialty group featuring primary care physicians as well as top specialty doctors, provides patients with consistent and convenient care throughout the tri-state region. Additional components include a freestanding Cancer Center, Urgent Care facilities, a network of preferred hospitals and doctors, more than 150 care locations, and multiple partnerships with other regional health care providers.
Note: Tablo customers have the ability to automate documentation with EMR Connect. Through a secure and encrypted integration, Tablo sends 70+ treatment fields, real-time updates and event-based alerts to the compatible EMR platform to automatically chart the dialysis results of patients.
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.
The views and opinions expressed in this blog post represent the personal opinions of the facility staff. The content should not be taken as medical advice. Never ignore professional medical advice in seeking treatment because of content you have read on the Outset Medical website.