Proudly Moving the Dialysis Field Forward – Cleveland Clinic Team Recognized with Pioneer Award
Tracy Coates, RN and Matthew Layne contributed to research and development of the Tablo® Hemodialysis System, leading to the Cleveland Clinic becoming the first hospital in the U.S. to deploy Tablo in its ICU, in 2017. To recognize their effort, the pair were recently honored with the Outset Medical Pioneer Award.
Cleveland Clinic has pioneered many achievements over its more than 100-year history, including breakthroughs in cardiovascular, neurological and transplant medicine. It is ranked among the top hospitals in the country, with visionary values that include a commitment to transforming healthcare through innovation. Over the past five years, its team has played a key role in evolving a long-stagnant field: hemodialysis for the treatment of kidney failure. Tracy Coates, RN and Matthew Layne (who goes by Layne), led by Director of Critical Care Nephrology, Sevag Demirjian, MD, contributed to vital acute dialysis care research and development (R&D) efforts involving hardware, software and other aspects of the first-of-its-kind Tablo® Hemodialysis System. To honor their essential contribution, Tracy and Layne were recently honored with the Outset Medical Pioneer Award, created by Chair and CEO, Leslie Trigg, to in her words, “acknowledge and honor the critical role of the early, intrepid pioneers that, because of their resolute fearlessness, fortitude and faith, patients’ lives are being improved today by Tablo.”
Significant milestones achieved by Tracy, Layne and team during this project include Cleveland Clinic becoming the first U.S. hospital to deploy Tablo in its ICU in 2017, successful pilots of earlier Tablo system generations and the first Tablo XT (Extended Therapy) treatment—now a standard modality. Here we introduce the award winners and the innovative, boundary-pushing Cleveland Clinic dialysis program.
To Boldly Go
Layne, Dialysis Technician Supervisor, has spent 20 years in healthcare, 14 in dialysis. He was the lead tech when the first Tablo systems were introduced at Cleveland Clinic in January 2017, and he ran the very first acute Tablo treatment in May of that year.
He credits his family as the foundation of his pioneering spirit. “My grandfather instilled in me that if I see a way that something can be improved or fixed, I don’t care if I get credit for it, I just want to push it forward.” Also, in the past his mother-in-law was a chronic dialysis patient, so he witnessed the toll that the disease takes on the patient and the family.
Layne’s altruistic and innovative nature served him well when Cleveland Clinic became involved in the ongoing development of Tablo. Dr. Demirjian initially introduced the dialysis team to the system in 2016, and was interested in their honest feedback.
“Dr. Demirjian asked us to look at every aspect of this new machine, and tell him whether it was worth pursuing,” says Layne. “I saw it as an amazing opportunity for our field to make positive change, both in the acute setting and for patients at home.”
“We are fortunate that Cleveland Clinic’s leadership trusts our judgment,” he continues. “I felt that if we could give Outset the ideas that they needed, we could have a truly beneficial technology to offer patients.” In 2019, Layne co-authored the “Early Experience with a Novel Hemodialysis System used for PIRRT Demonstrates Clinical Management at Lower Cost than CRRT and IHD” study, with Dr. Demirjian, Glenn Chertow, MD, and Luis Alvarez, MD, PhD.
Layne commented on his experience studying Tablo from a critical care and clinical versatility point of view. “I was impressed with how much the machine was focused on patient safety. I was also impressed at how responsive the Outset team was. They would listen to us, and follow through with the ideas that we provided.”
Tracy, with more than 20 years of dialysis experience, has served as Nurse Manager, Acute Kidney Dialysis, at the Cleveland Clinic Main Campus for the past four years. She became involved with Tablo when she took on her current role in 2018, and led the effort to introduce the novel system to the nursing and nephrologist teams, and incorporate it into their workflow.
She attributes her pioneering spirit to Cleveland Clinic’s philosophy of supporting innovation, clinical improvement and “outside-the-box” thinking among its providers. “Working in this supportive environment helped me to feel comfortable enough to express different ideas, and voice how things can be better. I love to brainstorm with Layne and other like-minded teammates to see the innovations that we can come up with,” she says.
“Dialysis had not changed much over my career,” Tracy continues. “It was hard to believe that this compact little box integrated not only the dialysis machine but also water purification, dialysate on-demand and automated treatment and disinfection logs. This is a new era of dialysis, and that’s what made Layne and I so excited.”
“This is a new era of dialysis, and that’s what made Layne and I so excited.” – Tracy Coates, RN
“Nurses usually have to deal with heavy RO [reverse osmosis] systems, along with large, high-maintenance dialysis machines. With Tablo, I began brainstorming all kinds of ways we could incorporate this technology into our practice and workflow. Layne and I worked together to troubleshoot issues and implement new ideas for our team. We also presented our own clinical data to the physicians, to get everyone on board with the new machine.”
Leveraging Technology Through a Pandemic
Tracy explains that their team’s problem-solving skills, backed by Cleveland Clinic’s support, helped provide much-needed hemodialysis treatments to patients during the worst of COVID-19.
“We had so many staff who were out at that time. Layne and I figured out how we could leverage technology to help us manage all these patients,” she says. “We had already been doing eight- to 16-hour PIRRT [prolonged intermittent renal replacement therapy] exclusively with our fleet of Tablo XT consoles, along with CRRT [continuous renal replacement therapy] with other machines in the ICU. In 2021, we decided that it would help ease pressure on our staff by moving this therapy to the day shift, where we usually do four-hour treatments using another IHD machine, one to one. We would now also add six-hour PIRRT treatments during the day using Tablo. We thought, the ICU nurses have already been trained on the machine, so let’s see if we can have one dialysis nurse or tech take care of four patients, with an ICU nurse monitoring the treatments.”
Because of the adaptive renal replacement capabilities of Tablo, their plan worked, and they were able to expand their dialysis program. “We provide IHD [intermittent hemodialysis] to patients who require that as well. It completely changed how we do dialysis,” says Tracy. She has also answered many inquiries from providers at other hospitals wanting to learn how their innovative program was staffed and organized.
“Tablo allows us to rethink our staff redistribution,” adds Layne. “When COVID hit, we didn’t know what to expect, but Tablo helped us to be prepared. The ICU nurses use the technology to take care of more patients with the same amount of effort. And, COVID is still a factor for us, patients with acute kidney injury [AKI] are still coming in.”
The award-winning teammates say that now, five years later, their Tablo dialysis program is going strong. They look forward to the future of their program with this technology. As for their advice to others: don’t limit yourself to what’s normal or what you’ve become used to. There is a better way.
And the Outset Medical Pioneer Award Goes to … Matthew Layne and Tracy Coates, RN
In recognition and appreciation of their pioneering, persevering, problem-solving inspiration and insights in the development of Tablo, and their essential role in Outset Medical’s story, Layne and Tracy were presented with Pioneer Awards on August 4, 2022 (they are pictured at the top of this page). The awards were given by Outset’s Vice President of Marketing, Jennifer Sipple, during a surprise gathering of Cleveland Clinic leadership and dialysis staff.
In accepting the award, Tracy commented, “I am very honored to have been chosen by Outset to receive this award, for something that we enjoy doing. This is nothing we could have expected. We’re also honored that Cleveland Clinic was chosen to help innovate Tablo. The fact that we helped develop its capabilities, for the good of all patients and staff who are using it today, is very satisfying. We even include this accomplishment as a selling point in our hiring process.”
“Receiving this award for my ideas was very unexpected, I am very grateful and honored,” commented Layne.
“Outset is forever grateful for this entire team, for Tracy and Layne’s leadership and for the entire staff that has worked through challenges along the way with Tablo,” commented Jennifer. “You helped Tablo continue to pioneer in the dialysis space and move us to where we are today. There are thousands of Tablo machines that you can feel very proud have your fingerprint on them, due to all the great feedback and learnings from the Cleveland Clinic over the last several years.”
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