Tablo at St. Mark’s Hospital: How In-House Conversion Set a New Standard in Dialysis Care
Summary
The Tablo Hemodialysis System enabled St. Mark’s Hospital in Salt Lake City to bring their dialysis program in-house from their previous outsourced service provider, resulting in a projected net savings of $450,000 in the first year. Their bold program is a role model for other hospitals in the region, and beyond.
The story of the impact of Tablo on St. Mark’s Hospital in Salt Lake City, UT begins with the passion of a team driven to offer the best possible care and outcome for critical patients that crash into dialysis. Over the course of a few short weeks beginning last April, while at the same time managing a nearly overwhelming surge in COVID-19 and acute kidney injury (AKI) dialysis patients, St. Mark’s converted an inefficient and costly outsourced acute hemodialysis and CRRT dialysis program to an in-house, all-Tablo model. Immediately upon conversion, the team began successfully treating with Tablo across all treatment modalities, including Slow Low Efficiency Dialysis (SLED), Extended Therapy (XT), and Intermittent Hemodialysis (IHD).
Following the conversion and the initial positive impact on its dialysis unit, the St. Mark’s team—led by Dialysis Nurse Manager Kasi Moore, Critical Care Director Jen Jellerson, and Dialysis Medical Director Tahir Zaman, MD—organized and published a study, presented as a poster abstract at the AKI & CRRT virtual conference earlier this month. The single-center report on 577 Tablo treatments performed at St. Mark’s Hospital from April through November of last year reported a net savings projection of $450,000 in the first year of its in-house conversion to Tablo (net savings estimated at $550 per treatment), as well as very positive training, user satisfaction, and treatment success data.
The success at St. Mark’s Hospital has also had a ripple effect on its community, driven by the growing prevalence of chronic kidney disease (CKD) and a rapidly expanding demand for dialysis in the Salt Lake region. Its in-house, all-Tablo dialysis program is serving as a role model for other hospitals in HCA Healthcare’s Mountain division, known in Utah as MountainStar Healthcare.
A Conversion and Launch Enabled by Ease of Use
Tablo was initially introduced to the St. Mark’s Hospital team by its corporate health system alliance in March 2020. Outset Medical team members worked to set up a fleet of Tablo consoles, and conducted a single four-hour training session with more than 20 ICU, floor, and HD nurses. Immediately after training and realizing the technology’s ease of use, the nursing teams went live with SLED treatments on Tablo.
At that time, COVID-19 cases were ramping up at St. Mark’s, and elective and non-emergency surgeries were put on hold. The team was becoming overrun with the need for dialysis, and they recognized that the outsourced model was no longer feasible.
“The team was becoming overrun with the need for dialysis, and they recognized that the outsourced model was no longer feasible.”
The very first Tablo treatment at St. Mark’s was performed on Easter morning, April 12, 2020 at about 1 a.m., by Jen Jellerson, and due to COVID protocols and precautions it was done with assistance from the Outset Medical team via text and FaceTime. “Jen is an absolute rock star, she really jumped in and made things easy. She created a positive environment and just ran with it,” says Justin Burningham, Outset Medical Tablo Program Specialist. After training ICU staff and the team gaining further experience and familiarity with Tablo, HD treatments outside of the ICU were transitioned in June.
At this same time, Moore was chosen to head up the conversion effort. Working with Jellerson and Zaman, she built out a robust dialysis department over the course of just a few weeks. This included researching and writing the extensive regulations involved, and interviewing and hiring a nursing team.
Raising the Bar in Patient Care
In terms of the impact of Tablo on her team’s workflow, Moore says that the system’s faster set-up, digital capabilities, and Extended Therapy (XT) treatment options help make her and her nurse’s jobs easier and more efficient every day.
The team is making extensive use of Tablo’s XT, that enables 24 hours of therapy at a minimum Qd of 50 mL/min. “XT has been a huge benefit to us, our team and nephrologists absolutely love having a 24-hour cartridge, and being able to bring the DFR [dialysate flow rate] down to 50 in order to clear very effectively and gently, and adjust the rate during treatment,” she says. “For a hemodynamically unstable patient, the ideal treatment is a prolonged therapy. We are able to accomplish this now with XT,” adds Zaman.
Moore notes how life-changing it has been for her nurses to be able to start emergency XT treatments quickly, and whenever they are ready (with an in-house intensivist who sets up the access lines). Another huge benefit she sees is being able to adjust therapies mid-treatment, based on a patient’s labs and her nephrologist’s instructions. “This feature, and the ability of Tablo to perform any modality, that we never had prior to our in-house conversion, is vital for patient outcomes,” she says. “And, with Tablo providing dialysate on-demand, I can change the sodium and bicarb settings during treatment. I love not having to wait and change out a bunch of bags.”
Additionally, the system’s scheduled saline flushes allow for less clotting and better success rates. “Patients have also mentioned that they have fewer chills and less cramping during treatment,” Moore adds.
TabloHub, a cloud-based support tool and part of Outset Medical’s digital ecosystem, allows for providers to easily access Tablo machine, treatment, service data, and training materials remotely. And, with continuous two-way wireless data transfer and cloud-based monitoring and reporting, Tablo automates documentation and streamlines machine management. These capabilities all work to optimize machine performance, reliability, and ease of use in any setting.
“The features built into Tablo have been particularly critical with COVID-19, as more staff resources are needed to provide a 1:1 nurse-to-patient ratio for these patients, no matter where they are in the hospital.”
– Kasi Moore
With the devices remote monitoring capabilities, the St. Mark’s team is also able to oversee multiple patient treatments at once, whether they are on-site or at home.
“The features built into Tablo have been particularly critical with COVID-19, as more staff resources are needed to provide a 1:1 nurse-to-patient ratio for these patients, no matter where they are in the hospital,” Moore says. “I also love that the system is always upgrading, and that Outset is always very receptive to any of the feedback that I give. It has been awesome.”
Tablo Expanding in the MountainStar Healthcare Network
So where does the St. Mark’s Tablo program stand today, nearly a year after its April 2020 launch? Jellerson notes that HCA Healthcare is very pleased with the rollout, and the positive recent study results.
What’s more, with provider education as a key driver, they are looking to replicate its successful model at other hospitals in its local network. A number of Tablo consoles have taken up residence at two sister facilities, Lakeview Hospital and Lone Peak Hospital.
“Our study showed a huge cost savings and high ratings on the training experience, treatment set-up and starts, and a 96.2% average success rate. We are proud to be leading the way forward in our region,” says Moore.
With positive patient outcomes and cost savings, a happy and engaged nursing staff, support from nephrologists such as Dr. Zaman, and in close partnership with the Outset Medical team, Jellerson and Moore are passionate about spreading awareness and educating providers about their exceptional Tablo experience, and inspiring conversions in their hospital network—and beyond.
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Meet the St. Mark’s Hospital Team
Dr. Tahir Zaman
Dr. Tahir Zaman practices clinical nephrology at the University of Utah Wasatch Kidney Specialists, with his main office at St. Mark’s. He attended medical school and trained at University of Washington, and then completed his residency and fellowship at the University of Utah. Now an employee of the University, in addition to his busy in-clinic and hospital nephrology practice throughout the Salt Lake valley he has served as the Medical Director of the St. Mark’s Hospital dialysis unit since July 2020. His passion is in helping his patients, with his main areas of interest including acute renal failure, renal replacement therapy including HD and PD, kidney transplant, and kidney stones, among other nephrological conditions.
“Having Tablo in-house has worked really well for us. It’s very intuitive to use. It has been a big benefit for the nurses, the system, the pharmacy, patient outcomes, and everything else from top to bottom,” he says.
Jen Jellerson
Jen Jellerson, Director of Critical Care at St. Mark’s Hospital for the past two years, directs a large team of nurses in the hospital’s 24-bed ICU and 34-bed PCU, that today is still in the thick of dealing with COVID-19. With more than 20 years of nursing experience, Jellerson’s previous roles have encompassed the ICU, ER, and NICU. She has also served as a house supervisor, coordinating staffing while monitoring the flow of patients in and out of the hospital.
Jellerson is passionate about uplifting her ICU staff to provide excellent care, as well as taking the time to teach chronic dialysis patients about things that they can do to manage their kidney disease more successfully and enjoy a better quality of life.
In the St. Mark’s Hospital critical care unit, she was overseeing the outsourced HD and CRRT dialysis program prior to the full in-house conversion to Tablo. She notes that the outsourced model impacted quality of care for their patients and efficiency of care, as there would often be delays in treatment due to issues with machine set-up and dialysate bag prescriptions—not an ideal situation for a critically ill population.
“The biggest takeaway for me is that having Tablo in-house has really elevated our dialysis program. The transition to in-house has helped our staff tremendously, they have a much higher level of satisfaction. We also have a lot of nurses who want to learn how to use it, and it’s helped our patients get treated faster,” says Jellerson. “Seeing my nursing team empowered since our transition to Tablo has really been amazing,” she continues, with emotion evident in her voice. “It’s about people, that’s the whole reason we do this.”
She also notes that Tablo’s ease-of-use and competency among the nursing staff has had an overall positive ripple effect on the whole hospital, including many floor nurses talking about how much better their dialysis patients are doing.
“Everyone loves Tablo, it’s so much better. I haven’t had one nurse who has said ‘I wish we had those big awful machines,’” says Jellerson. “At least for the ICU, it’s made 24-hour runs such a more viable option, that you can implement so much quicker. Our nurses are all proficient in Tablo—we can just grab a machine and start treatment. I really feel like we utilize extended treatment much more than we did before, which benefits patient outcomes. And for our HD patients, they do tell us after treatment that ‘I feel so much better than I usually do’”.
Kasadi (Kasi) Moore
Kasadi (Kasi) Moore began her nursing career 16 years ago, in 2005, first as a long-term acute care (LTAC) nurse and then at University of Utah’s neurocritical care unit. She then spent several years at Primary Children’s Hospital in Salt Lake City, handling child abuse exams. She then moved to the critical care unit at Intermountain Medical Center, while also working in emergency care in a small community hospital in Orem, UT. She then came on at St. Mark’s Hospital as part of the critical care float pool, working in the ICU and ER. She then moved exclusively to the ICU, trained with the cardiovascular surgery team, and then served as a house supervisor. In May of 2020, she took on her current role as Dialysis Nurse Manager at St. Mark’s, realized her passion for dialysis, and took on the Tablo program build as her personal mission to make a meaningful difference in treating patients with ESRD and AKI.
Moore’s passion is providing the very best possible care for patients and getting them in the best place they can be. In support of that goal and wanting to also make life easier for her nursing team, Moore obtained her master’s degree in Nursing Informatics, a specialty that integrates nursing science, computer science, and information technology/patient data. Through that work she realized her passion for research and the use of data as a tool to improve quality of care.
When St. Mark’s converted to Tablo, it was a perfect fit for her background and passion for patient care, as she and her team can adjust treatment parameters based on each patient’s needs and positively impact their quality of life, from ICU to bedside. As part of her new role, Moore proactively researched optimal strategies for implementing and growing an in-house dialysis unit with the American Nephrology Nurses Association (ANNA), among other resources, while also working closely with the Outset Medical team.
In addition to leading and maximizing the benefits of the in-house conversion at St. Mark’s Hospital, Moore’s longer-term goal is to be able to send more HD patients home with Tablo. “With dialysis, it’s all about the quality of care. I think that quality of life is so much more important that quantity, and if we can provide that through our treatments, then that’s what we should do. It’s what our patients deserve,” she says.
Her advice to others who might be considering Tablo: “Be positive, there are going to be things that happen while you’re implementing—just slow down and follow the steps, the machine walks you through it each time, step by step. You don’t need to snap and tap the lines. It’s also important to have a management team that is forward-thinking and open to seeing that Tablo is just as efficient as other machines. You can’t argue with the numbers. Also, Outset is dedicated to making its system better and better, so that it works for you,” she says.
ABOUT ST. MARK’s hospital
St. Mark’s Hospital is a 316-bed multi-specialty acute care hospital with a busy 24-bed ICU unit. Originally founded in 1872 as Utah’s first hospital, St. Mark’s has been growing and adapting to fit the needs of the community it serves. In 2020, St. Mark’s Hospital was recognized for the seventh time as an IBM Watson Health 100 Top Hospital in the “Teaching Hospitals” category. It was also named an Everest Award winner, which recognizes hospitals for top rate of improvement over a five-year period, by IBM Watson Health.
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