How a Trailblazing Community Hospital Went from Crisis to Confidence
July 2022
Summary
Carolina Pines Regional Medical Center is the first in its service area to bring its acute dialysis services in-house with the Tablo® Hemodialysis System, capturing the attention of dialysis programs around the country.
South Carolina has some of the highest rates of hypertension and diabetes in the nation, and for the small, rural community of Hartsville, this means a growing kidney disease population and demand for dialysis. One of the only hospitals serving the town and surrounding counties, 116-bed Carolina Pines Regional Medical Center, offers dialysis as an important inpatient service line. This past winter, the hospital was faced with two simultaneous challenges that required a novel solution.
First, it was inundated with some of the highest COVID-19 census numbers since the pandemic began, with many patients requiring dialysis for kidney failure. Carolina Pines’ dialysis numbers, which pre-pandemic totaled 40 to 55 treatments per month, rose to 75 to 100. Leadership also decided to transition its dialysis program from an outsourced to an in-house service line in the hospital’s ICU and dialysis unit, to help meet the increasing demand.
“We had to step up to meet the needs of our community, and for this we knew we had to do something different and innovative,” says Chief Nursing Officer Christy Moody, MSN, RN, CCRN-K, CPPS.
To add to this pressure, the hospital has seen an influx of emergency department (ED) admissions from the two overpopulated outpatient dialysis clinics in Hartsville, where challenges for chronic patients include difficulty getting chair times, transportation and travel time, and treatment noncompliance.
The Carolina Pines team convened to look at ways that they could address these issues by quickly bringing their dialysis line in-house, and at the same time provide exceptional patient care.
New Year, New Service Line
“It was clear that we needed to bring this service in-house,” says Chief Medical Officer, Brian Sponseller, MD. Dr. Sponseller had heard about a new dialysis technology, the Tablo® Hemodialysis System, from a medical colleague. Then, Outset Medical introduced the system at an onsite demonstration event. After the team learned about the ease of training and use with Tablo, along with the labor and supply cost savings potential, he and Moody let corporate know that they were interested in converting their program.
“The staff really stepped up and wanted to learn about the innovation built into the new machine.” – Christy Moody, MSN, RN, CCRN-K, CPPS, Chief Nursing Officer
“We quickly were able to see the potential for significant cost savings. Dr. Sponseller then said ‘alright, let’s get Tablo in here.’ We got approval and moved quickly,” says Moody. The team ordered a fleet of Tablo XT (Extended Therapy) machines, capable of up to 24-hour Adaptive Dialysis: the unique ability of Tablo to span a wide spectrum of treatment modalities, from intermittent to prolonged dialysis of up to 24 hours daily, with or without ultrafiltration (review Tablo clinical evidence here). They also hired two experienced dialysis nurses to help lead the new program, both in the ICU and inpatient dialysis unit.
“We went from ordering the machines in January 2022, to our first patient on March 28,” says ICU Director and Dialysis Director, Ashlee Horton, CCRN.
“The staff really stepped up and wanted to learn about the innovation built into the new machine,” adds Moody. “They recognized quickly after working hands-on with it during our brief staff training that it was going to be easy.”
Educate and Empower
The nursing staff was trained quickly, using Outset Medical’s online learning platform called Outset University. “The nurses logged onto Outset University and did the training module, and then a clinical educator from Outset spent two weeks with us. Their team was very supportive with our go-live,” says Horton.
At Carolina Pines, nurses can perform acute intermittent hemodialysis (IHD) or longer-duration treatments in all 12 ICU beds and nine in the step-down/progressive care unit. “Dialysis can be performed in the patient’s room, with an ICU or dialysis nurse,” Horton continues. “Also, our dialysis or ICU nurses can treat patients in a three-bay area outside of the ICU, where they also dialyze non-ICU patients. We have a lot more flexibility with our nursing staff.”
Bringing on Tablo also eliminated the traditional need for different dialysis machines in the ICU versus the dialysis unit. “It’s a big deal that now we actually employ our dialysis nurses and that they and our ICU nurses are competent on Tablo,” says Horton. “They work very closely together to help with treatments in the ICU. It has allowed us to offer more treatments in both departments because both teams are trained on one easy-to-use system.”
Carolina Pines has also seen an impact on length of stay and other efficiencies. “From a scheduling standpoint, we can prioritize who gets run,” says Dr. Sponseller. “If someone’s being discharged, they get treated first. It has helped us get patients home earlier in the day, especially if they need dialysis. And Tablo has helped us achieve excellent clearances efficiently, without clotting issues and with a lower dialysate flow rate. Our nephrologists have been really satisfied with it, and so have patients. Tablo has allowed us to be more flexible with our dialysis program and do what is in the best interest of the patient.”
The staff is also relieved to no longer transport large reverse osmosis (RO) machines along with the large, cumbersome dialysis equipment they were using previously. And, set-up is much faster and easier. “Set-up and priming used to take about 45 minutes,” says Horton. “Tablo brought set-up time down to about 15 minutes. We’ve also found that alarms are generally simple to resolve, and water testing is quick and easy. And, with our little, tiny supply room, the amount of supplies we now order is tremendously reduced.”
The Carolina Pines team has been fielding requests from around the country for information and site visits to learn more about their program.
Sharing Their Experience
Being the first program in its service area to fully convert to an in-house Tablo dialysis model, word has spread quickly. The Carolina Pines team has been fielding requests from around the country for information and site visits to learn more about their program. “We literally have almost a call a day with a facility that is looking at a conversion but concerned about the hardship on their nurses, or those that are planning to implement Tablo,” says Moody. “It’s been such a good win for our facility, and we love sharing the news with folks. I tell them that with the cost savings, patient satisfaction and decreased nursing resources, it really is a no brainer. It’s exciting to think about the possibilities for this device in the future.”
ABOUT CAROLINA PINES REGIONAL MEDICAL CENTER
Carolina Pines Regional Medical Center provides quality healthcare services to the people of several counties in northeastern South Carolina. Patients have come to rely on our experienced, skilled staff and physicians to provide them with the highest level of care and compassion. Through the facilities on our campus, including a 116-bed acute care hospital and an adjoining medical office building, we provide comprehensive services with two things in mind: the care and comfort of our patients. We are a member of ScionHealth, a for-profit hospital network headquartered in Louisville, KY.
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* Tablo Hemodialysis System Disclaimer:
Results may vary. Keep in mind that all treatment and outcome results are specific to the individual patient. For safety and effectiveness information, indications for use, risks, cautions and warnings, please refer to the product labeling.