Changes in the In-Hospital Dialysis Unit

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The provision of in-hospital dialysis services over the next decade will necessitate a rethinking of the unit infrastructure, coordination of resource allocation, application of newer dialysis techniques, attention to data management and quality targets, and the continuous development of dialysis personnel.

The in-hospital unit in actuality is a hybrid unit, caring mostly for hospitalized end-stage renal disease (ESRD) and acute kidney injury (AKI) patients who require dialysis, but also serving a significant number of ESRD and AKI outpatients.

Our in-hospital dialysis unit relocated to a state-of-the-art facility on the 6th floor of the Glickman Tower last year. The new location provided the opportunity to expand from 12 to 21 beds in response to the increasing number of   patients who are transferred to Cleveland Clinic for complex issues or who develop AKI during their hospitalization. 

The number of treatments during the past five years averaged 12,950 a year and is expected to grow. Of these, nearly 4,800 (37%) treatments are performed in the specialized in-hospital dialysis unit; the remainder in the ICU .The average acuity score for patients dialyzed in the in-hospital unit is 3.47.

Because hospitalization outcomes and length of stay are keenly linked to the quality of each dialysis treatment, the electronic medical record (EMR), in addition to a knowledgeable staff, is critical to our understanding of the patient's condition and in the effective communication between the medical team, actual dialysis treatment site and the nursing floor team.

During the past six months, we developed a system wherein all dialysis orders are placed directly into the EMR. In the next 12 months, a linkage will be completed connecting the actual dialysis machine to the EMR for automated individual dialysis treatment data transfer. This will automate data transfer for all events that occur during the treatment and assist with quality data management in the future, a critical component for improving overall patient outcomes.

The standard outpatient dialysis prescription may not be tolerated by all ESRD patients, requiring further evaluation to determine the optimal dialysis treatment design critical to ensuring optimal treatment tolerance and laboratory results.

Our unit will provide patients who experience difficulty with standard OPD dialysis treatments, an opportunity to be evaluated with diagnostic dialysis protocols bringing together nephrologists, cardiology, nursing, and additional specialty areas in an integrated approach aimed at improving an individual's tolerance of the dialysis procedure without experiencing complications that add to the morbidity of the procedure and interfere with quality of life.

In addition, newer approaches to measuring body composition and volume will be tested in dialysis patients who have experienced complications related to ineffective volume regulation with dialysis, such as hypervolemia, which can lead to increased morbidity, hospitalization rates, and shortened patient survival.

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