Melinda Patterson: Nursing Leadership that is Moving Mountains
April 2022
SUMMARY
This VP of Nursing Operations is working alongside her team to bring dialysis best practices to the 11 HCA Healthcare Mountain Division hospitals.
Melinda Patterson, DNP, MSN, RN, NE-BC, is a nurse executive who exemplifies the meaning of
leadership, by inspiring and motivating her teams to reach their highest potential by working through solutions right alongside them. Patterson, a past critical care nurse, serves as Vice President of Nursing Operations at HCA Healthcare Mountain Division, that includes 11 hospitals spread across Utah, Idaho and Alaska, many of which have been recognized among the nation’s “Top 100 Hospitals” by IBM Watson Health. It is one of 15 divisions operated by HCA Healthcare, one of the leading U.S. healthcare systems with 182 hospitals and more than 2,300 sites of care in 20 states. One area where HCA as an organization has been working to competitively drive efficiencies in its processes and delivery models is dialysis care. It is currently doing that through an investment in innovation: a network-wide implementation of the Tablo Hemodialysis System, in place of traditional, costly and resource-intensive dialysis machines.
Patterson works with nurses across all the division’s hospitals to ensure that they’re supported and utilizing their scope to the fullest. And she jumps in and leads by example. “I think that as a leader you guide by participating and promoting a new technology from a true perspective, by being there with the nurses, talking through it, and learning and touching the device,” says Patterson. “Patient care is still my center, and I got to experience Tablo with the frontline nurses, so I knew for sure that it was a great fit.”
“I’ve been a nurse for 25 years and the dialysis machines I used when I first started were the same cumbersome and time-consuming machines the last time I worked as a bedside nurse. That’s a long time for a machine not to change,” she continued. “But the more I learned about Tablo, I could envision what its ease of use could mean for our program, and everyone got excited for this conversion project. I want our patients to have the best of healthcare and I’m grateful that I work for HCA that wants to implement best practices, like Tablo.”
Patterson and her team, including Kasi Moore, MSNI, RN, Dialysis Market Director, who was spotlighted in a previous story about the Mountain Division’s St. Mark’s Hospital in Utah and its successful Tablo conversion in 2020, have been overseeing implementations across the division’s many ICUs and dialysis units. As of this April, seven out of 11 of its hospitals have successfully converted their outsourced and insourced dialysis services to an almost exclusively all-Tablo in-house dialysis model. This includes St. Mark’s, Mountain View, Lakeview, Ogden Regional, Eastern Idaho Regional, Timpanogos Regional and Alaska Regional. One more Utah hospital, Lone Peak, is being converted in the coming weeks, with additional sites scheduled through 2023.
“As we’ve implemented Tablo across our division, we’ve streamlined dialysis nursing and ICU care, decreased costs, increased volume, kept our patients in-house, and have been able to prescribe and start treatments quicker. Our physicians and nurses have been happy. The experience has been truly incredible, and I’m incredibly grateful to our team,” says Patterson.
Five Concurrent Conversions, Efficiencies Across the Board
In August 2021, she and her team led the effort to go live with Tablo simultaneously in the dialysis and ICU units across five of their hospitals in Utah and Idaho, and Patterson participated at every nurse training. “That took a lot of coordination, but it ran very smoothly,” she says.
The key to success with these concurrent go-lives in her view was the ease of nurse training, the simplicity of the Tablo touchscreen, TabloHub cloud-based system monitoring across their geographically distanced division, and support from the Outset team. “I like that the machine prompts you through everything you need to do. It’s very intuitive. And we felt very supported by Outset through the whole process.”
Since bringing Tablo in-house across seven of their division hospitals starting two years ago, Patterson has seen improved efficiency in many areas, including supplies, volume, nursing resources and workflow—the latter being especially critical during the COVID crisis.
Advancement of Care Through Technology: Setting a New Standard in Dialysis Care
(See page 31 of this HCA report)
She says that since converting to a single dialysis platform, the supplies have been easier to order, manage and store, and costs are down significantly. “As I learned more about it, it was incredible how much went into dialysis that has been slimmed down with Tablo,” she says.
“It really helps a lot that dialysis is standardized across the division,” adds Moore.
Patterson notes that dialysis treatment volume in many of their facilities has exponentially increased beyond expectations. “We then had to work a budget in for more Tablo machines because nephrology and the teams really like it, and they’re using it much more,” she says.
“The other nice piece is ease of use. We can take Tablo into a medical-surgical patient’s room at the bedside, without having to juggle labs and bags, so transport and accessibility challenges have definitely decreased with using the machine,” Patterson continues.
Moore says that the nurses quickly accepted and learned how to use all the treatment modalities that Tablo offers. “We had a rapid acceptance with our ICU nurses across the Utah market, in doing Extended Therapy [XT; up to 24 hours] and SLED [sustained low efficiency dialysis] treatments with Tablo. Our hemodialysis nurses have been very happy with it also. They were able to rapidly start to train each other on how to use the machine, and travelers from other markets have been able to easily integrate into our teams,” she says.
Tablo has also had a huge impact on the division’s ICU ratios. “Our nurses don’t have to be one-to-one with a Tablo dialysis patient, you can use standard ratios,” says Patterson. “It’s given us the opportunity here in Utah to explore having dialysis techs set up and take down the machines, where previously we didn’t utilize them in that capacity.”
Patterson also views the Tablo system’s unique Adaptive Dialysis capabilities, including XT, as an important competitive advantage.
“Kasi has done an exceptional job at hiring well-trained nurses,” she adds. “It’s been interesting also, once dialysis nurses find out that we utilize Tablo they’re very interested in coming over, so it’s been really helpful.”
Patterson also views the Tablo system’s unique Adaptive Dialysis capabilities, including XT, as an important competitive advantage.
“Our bigger hospitals have the XT machines for high-acuity, hemodynamically unstable patients and I think that’s important, especially if other health systems are not using Tablo or XT, that offers us the opportunity to serve our communities in a better way,” she says.
During COVID surges, the Mountain Division had to keep a close eye on critical care resources, as was the case everywhere. Because of the treatment modality flexibility and ease of use with Tablo, their teams were able to spread nursing resources out a bit more, and cross-train and provide support anywhere where dialysis was happening in the hospitals. “Tablo definitely helped with our critical care staffing and helped us manage some of those challenges during COVID spikes,” says Patterson.
Envisioning the Future
Patterson’s future plan is for all 11 of the division’s hospitals to be able to use Tablo. She and her team have also been consulting with sister HCA Healthcare facilities in other states that will be going live with Tablo this year.
Down the road she envisions a Tablo Home program as well, with the device’s flexibility across all avenues of care. “I’ve learned a great deal in the last year and a half with this and I am excited to see what’s ahead. And, the more opportunity we give our patients to be at home to receive their care, I see that being a vital unmet need that we are planning to put into place.”
ABOUT HCA HEALTHCARE MOUNTAIN DIVISION
With headquarters in Cottonwood Heights, Utah, the HCA Mountain Division is a leading healthcare system in three states. Branded as MountainStar in Utah, our healthcare system includes eight hospitals in that state along with two in Idaho and one in Alaska. To increase access to high-quality patient care, our system also includes a freestanding emergency department, 10 stand-alone surgery centers, three satellite imaging centers, and nearly 60 physician clinics. Our parent company, HCA, is the nation’s leading provider of healthcare services. HCA has provided medical expertise and state-of-the-art care to patients for four decades.
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