Almost half a million Americans depend on chronic dialysis therapy to survive. More than 90% of these individuals receive thrice-weekly hemodialysis treatments in an outpatient dialysis clinic. They are often sick and require frequent emergency department (ED) visits and hospital admissions, leading to the bulk of their medical care expenditures.
Medicare and Medicaid cover virtually all costs related to ED care and hospitalization of these patients. Not infrequently, dialysis patients need to be admitted for an additional dialysis treatment to remove extra fluid or potassium. Dialysis patients frequently experience infectious diseases such as pneumonia and bacteremia that require antibiotic treatment or encounter vascular access problems requiring a placement of a temporary central catheter for dialysis.
These problems often happen afterhours or over the weekend. Our healthcare system channels dialysis patients with such problems to the ED, leading to substantial costs and resource consumption and patient dissatisfaction. But there may be alternatives to cut down on the number of ED visits by dialysis patients.
In one of my recent overseas trips, I was fascinated by a visit to a state-of-the-art dialysis urgent care center in Chennai, India, where walk-in dialysis patients are welcome 24/7. The two-story building is no larger than our average dialysis centers in the U.S., but it has more to offer. In addition to 20 dialysis stations and regular dialysis shifts, it is also equipped with an X-ray area where chest X rays and KUBs can be performed. This was supported by round-the-clock radiology technicians and physician coverage.
Problems such as pulmonary edema can be diagnosed and extra-dialysis sessions offered any time of the day and any day of the week. Basic blood or urine tests, including chemistry panels and CBCs, can be done within minutes so that hyperkalemia and other electrolyte abnormalities can be detected and managed immediately. Blood cultures are drawn and patients can be provided with empiric intravenous antibiotics under physician supervision. Electrocardiograph machines and pulse oximeters provide additional evaluations.
The center even has a small but well-equipped procedure room, so central catheters can be placed and even thrombectomies can be performed. Fascinated by this high degree of efficiency in provision of fundamental health care to dialysis patients, I envied them for what they have in their fast growing and emerging economy and what we don’t have in our highly developed and regulated country.
Some may say that X-ray imaging procedures are too technical for a dialysis center, but I would point out that dental offices are already equipped with them, so there is no excuse for us not have such 24/7 walk-in dialysis urgent care that could substantially reduce costs, circumvent unnecessary ED visits and hospitalization, and provide better patient care and outcomes.
Let’s hope that one day we too value efficiency and promptness in health care delivery with such innovative approaches.