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Dialysis Clinic
Process
Improvement
Analysis
Adam Roy
Dorothy Fisher
Janelle Bryant
Joel Mikuta
Sherri Mesquita
Michelle Himes
2
Dialysis Overview



60% of Dialysis patients are ambulatory and are
transported by way of ambulatory services
The majority of patients are Medicare vs. Medicaid
Each patient’s treatment at the clinic is about 3-4
hours, 2 to 3 days per week.
3
Types of Treatment Areas
Hemodialysis
-is the most common way
treat advanced kidney failure.
to
The
blood is pumped out of your body to an
artificial kidney
Requires
patient to follow a strict treatment
schedule, take medications and, usually, make
changes in diet.
Treatment Area
 Peritoneal
Dialysis-Peritoneal dialysis (PD)
has been a widely accepted method of
treating end stage renal disease
(ESRD) the most common method of
home dialysis.
 While
many dialysis patients in the United
States go to a dialysis center, PD offers
more flexibility by allowing patients to
dialyze at home, at work or on vacation.
Patient Treatment Needs

Patients have a team of Nurses, Dietician,
and Social Worker

Fluid Restriction

Patients have a strict Kidney Diet
Current State Process
Common Process “Pain Points”
Issue # 1
Incidence of bloodstream infections related to dialysis
treatment
Bacterial
infections are most common type
37,000 infections annually in the U.S.
$23,000 per related hospitalization
Issue # 2
Extended patient wait times for treatment
Creates
a domino effect for other patients
Increases clinic staff stress level

Leads to errors and often further delays
Process
Improvement/Solutions
Issue # 1
Incidence of bloodstream infections related to
dialysis treatment
Solution
Development /implementation of staff-level
checklists at key points where infections can occur


CDC-recommended
Requires active management oversight and auditing
to ensure staff compliance
Facilitate
staff training around the need to follow
proper protocols relative to venous site infection
prevention
Process
Improvement/Solutions
(Cont’d)
Issue # 2
Extended
patient wait times for treatment
Solution
Implement process workflow reengineering utilizing “lean”
principles
Limit # of patients beginning treatment at any given time
 # is dependent on clinic size
 Critical to manage patient expectations
 Routinely audit process for course corrections
Facilitate
staff training around the need to stagger
patient appointment times
Future State Process
Process enhancement points
11
Performance Metrics
Issue # 1
Incidence of bloodstream infections related to dialysis treatment
Measurement (A): # of catheter-site infections vs. current baseline
Frequency: Metric calculated and reported to the National
Healthcare Safety Network (NHSN) and appropriate clinic staff
members every 30 days
Goal: Reduce infection rate by 50% within the initial 60 days
Measurement (B): Auditing of recommended practices around
central venous catheter care, minimum scrub and soaking time
for antispetics and proper hand hygiene/gloving practices
Frequency: Monthly observational audits and staff re-training on
an as-needed basis
Goal: Conduct at a minimum one formal audit each 30 days and
informal audits on an on-going basis
Performance Metrics
Issue # 2
Extended patient wait times for treatment
Measurement (A): Average patient wait time to begin treatment
vs. current baseline
Frequency: Metric calculated monthly and reported to
appropriate staff members every 30 days
Goal: Reduce average wait time by 30% within the initial 30 days
and 50% within 60 days
Measurement (B): Patient customer satisfaction levels (specific to
treatment wait times), as reported by a random survey distributed
each week
Frequency: Metric calculated monthly and reported to
appropriate staff members every 30 days
Goal: Increase patient satisfaction rates around wait time by 50%
in terms of favorable responses versus baseline
Measurement (C): Staff satisfaction/stress levels, as reported by a
self-reporting survey
Frequency: Metric calculated monthly and reported to
appropriate staff members every 30 days
Goal: Increase overall staff job satisfaction level by 25% (30 days)
and 50% (90 days) versus baseline
Conclusions

Dialysis clinics serve a critical need for a sensitive patient
population

Key process improvements can be centered around:
 Customer service (reduced wait times/delays)
 Patient safety (reduced catheter site infections)
 Staff job satisfaction (reduced self-reported stress
levels)

Routine monitoring/reporting/training is critical to
ensuring the above improvements remain
impactful moving forward
Reference Material
http://www.nephrologynews.com/articles
/109727-how-applying-lean-principles-indialysis-improved-efficiency-and-patientsatisfaction
Questions?