How PAM Health Cleared a Path to Doubling its Dialysis Capacity
PAM Health Rehabilitation Hospital of Greater Indiana solved hemodialysis staff issues and doubled the number of patient treatments after converting to an in-house model that has already seen tremendous success across the PAM Health network.
Waylon Maynard, BBA, RN, BSN, MHA, CEO of PAM Health Rehabilitation Hospital of Greater Indiana in Clarksville, recently led a transformative conversion at his new facility after reaching a critical juncture: no new patients requiring hemodialysis (HD) could be admitted.
Driven by the pandemic, nursing staff shortages at its outsourced dialysis provider had created numerous roadblocks to PAM Health Greater Indiana’s operations, as many of its patients require HD along with other rehab therapies. In late 2021, the dialysis provider restricted the number of treatments its staff could do per week, even though the demand for dialysis was growing. Additionally, delays and sub-optimal patient response to treatment on the older dialysis machines were impacting the mandated timing of patients’ other rehab therapy needs. The situation impacted Maynard’s referrals and admissions on the front end, and ability to grow and expand the business. But, as PAM Health’s focus is on providing exemplary high-quality, transformational healthcare to patients in the communities it dutifully serves, there was an already-proven solution.
Over the past couple of years, the PAM Health nationwide network has been successfully rolling out a full conversion of its dialysis services to an in-house model with the Tablo® Hemodialysis System, across all of its long-term acute care (LTAC) and acute inpatient rehabilitation facilities (IRFs). Maynard and other administrators decided it was Greater Indiana’s turn to make the switch.
“Everything we do here, in addition to providing exemplary care, is about the patient experience,” says Maynard, who has 30 years of nursing and 25 years of healthcare management experience. “I knew that there were other PAM Health facilities that had quickly and successfully transitioned to Tablo, but I will admit that I was intimidated at the thought of introducing a new in-house service. In October 2021, we started having weekly calls with the Outset team and the larger PAM Health team to plan the conversion and go-live. It was an exceptionally well-planned and smooth experience with Outset, probably the best compared to any type of medical device launch that I’ve ever been associated with. That team took away all the fears that I had, and we felt like we were in comfortable, competent hands. We treated our first patient on Tablo in March 2022, and our program has taken off since then.”
Since converting from an outsourced provider to Tablo, the PAM Health Greater Indiana team has been able to grow their HD program and get patients the occupational, physical and other rehab therapy that they need. In late 2022, the nursing team was actually able to double the number of dialysis treatments it provides weekly, in comparison to the previous outsourced provider.
“Tablo fits right into our wheelhouse and our ‘we care’ philosophy,” Maynard continues. “Patients deserve the best that’s out there and this has helped us to really transform hemodialysis here in our community and offer a better product, a better experience and better outcomes.”
Since converting from an outsourced provider to Tablo, the PAM Health Greater Indiana team has been able to grow their HD program and get patients the occupational, physical and other rehab therapy that they need.
Expansion Roadblocks Solved, Efficiencies Increased
Maynard and his team explain how their facility was able to address the critical nursing staff and HD issues it had with its outsourced dialysis. “In an inpatient rehab facility like ours, our patients need to meet the CMS-mandated three hours of therapy a day, referred to as the ‘three-hour rule,’” he says. “Our goal is to give them that multidisciplinary combination of physical, occupational or other therapy that they need. The issue was that the old dialysis machines seemed to wipe patients out, and their treatment days in some cases became a wash. We struggled at times to try to meet the three-hour indicator with those machines, rehab would be delayed, and we even had to ship patients out to other facilities for treatment. Now with Tablo, we’re seeing greater participation, with patients being able to do full days of rehab on their dialysis days.”
Keishaundria Wright, HDRN, is Director of Quality Management at PAM Health Greater Indiana, where she also manages the hospital’s in-house hemodialysis program. With her background in dialysis clinic settings, she says that the ease of use with Tablo has changed her perception of dialysis. “With the old machines I used to use, just the stringing alone was intimidating. The first time I saw someone stringing one of those machines, I thought that I’d never be able to learn how to do that. But with the Tablo cartridges, they’re pre-strung, so you just pop them in. Also, the priming takes such a short amount of time, and I don’t see priming errors with Tablo like I did with the other machines.”
She also likes that having Tablo consoles in-house has eliminated problems with water that they used to have to manage, and everything about the system is simple. “We don’t need a water room. We have water fixtures in the walls of our patient rooms, which is nice,” she says. “Just being able to have acid and bicarb in a jug with a straw was something that just really blew my mind. Returning a patient’s blood is just one clamp and one push of a button. It’s a very complicated process on other machines to return the patient’s blood. Treatment data is also automatically uploaded from the Tablo machines into the cloud, which makes our quality management that much easier.”
“When you think about a dialysis machine, they are usually intimidating for those of us who are non-dialysis nurses. Tablo removes that intimidation factor. It has revolutionized dialysis and the way our programs used to run on the old-school machines,” adds Maynard.
Melissa Walker, Chief Nursing Officer (CNO) at the hospital through December 2022 and now Corporate Clinical Resource Specialist, pointed out that the Greater Indiana team was impressed from the day that the Tablo consoles were rolled in, and has seen efficiency improvements as well. “Outset created a ‘wow’ experience here for us, from both a patient care and a healthcare provider standpoint,” she says. “The machines look very cutting edge and innovative. That’s what we’re all about here at PAM Health and this hospital, and so it was a natural fit for us to be able to remove those previous barriers with taking HD patients. We were finally able to open the flood gates and bring in those patients.”
“When you think about a dialysis machine, they are usually intimidating for those of us who are non-dialysis nurses. Tablo removes that intimidation factor.” – Waylon Maynard
“From a process standpoint, Tablo has increased our efficiencies, for example the turnaround time on cleaning and setting up the machines in between treatments,” she continues. “It’s been huge for us to treat these patients in-house and not have to transport them back and forth to another facility. If we have a patient that needs an extra treatment, we’re not at the mercy of an external source to bring staff in to do that. I can’t speak highly enough about it. It’s a great service, and we’re the only facility in the Kentuckiana area that’s offering it.”
Khurram Nazeer, MD, is a nephrologist with Bluegrass Kidney Consultants, and PAM Health Greater Indiana’s medical dialysis director, where he manages inpatient dialysis and all the chronic kidney disease patients at the facility. Wright and Dr. Nazeer were brought on in early 2022, when Tablo was implemented.
Dr. Nazeer says that the time saved by the nurses is a major improvement that he has seen. “We now have two dialysis nurses running about 50 treatments a month. That would not always be possible with the older machines, with all the things they had to do with set-up and takedown, the time spent between treatments, cleaning of the machine, and problems such as clotting. I definitely see a big difference with Tablo. It has been a major gamechanger for our nurses and dialysis program, and that is amazing to me. We are glad that Tablo is here and I think it is here to stay.”
Patient Experience is Key
Tablo creates an important favorable impression for patients who are new to hemodialysis, says Walker. “The machine is much less intimidating. We get a lot of positive feedback from patients, and they like to see how it works.”
“I like to paint to the picture of dialysis treatments being more like of a spa-like experience for patients, since the machines are so small and the chimes are pleasant,” she continues. “It can be more of a soothing and relaxing type of environment for patients and their families, instead of the startling alarms that you get with the other HD machines, and just the intimidating, overbearing size of some of them. This is especially useful for our acute kidney patients, where this may be only their second or third HD treatment by the time they come to us.”
For other facilities that might be considering bringing Tablo in-house, the PAM Health of Greater IN team recommends that they do it, and also cross-train their staff. “As simple as Tablo is to use, even the nurses who may not have been interested in HD actually take an interest in this because of how simple it is,” says Wright. “Cross-training is something that I have been an advocate for, so everybody can be knowledgeable and able to use this device.”
“We’ve definitely seen our Tablo program grow, and are excited to see it continue to grow,” adds Maynard. “We are here for our community. For us, Tablo is about being a good partner to our community and the patients we serve.”
About PAM Health Inpatient Rehabilitation Hospital of Greater Indiana
At PAM Health Rehabilitation Hospital of Greater Indiana, we are dedicated to helping patients recover from acute illnesses and injuries. Located in Clarksville, our beautiful rehab hospital is equipped with the latest therapeutic equipment and staffed by a caring team of medical experts, we can provide comprehensive inpatient and outpatient care to help you achieve your goals. Watch our promotional video here. Connect with Waylon Maynard on LinkedIn.
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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. Please consult your physician for a complete list of indications, warnings, precautions, adverse events, clinical results, and other important medical information. It is important that you discuss the potential risks, complications, and benefits of this product with your doctor prior to receiving treatment, and that you rely on your physician’s judgment. Only your doctor can determine whether you are a suitable candidate for this treatment.
For safety and effectiveness information, indications for use, risks, cautions and warnings, please refer to the product labeling for the Tablo Hemodialysis System.