Abstract: SA-PO622
Characteristics and Outcomes of High-Acuity Patients Referred for Outpatient Dialysis
Session Information
- Hemodialysis: Case Reports, Series, QI Projects
November 04, 2023 | Location: Exhibit Hall, Pennsylvania Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Green, Gopa B., Satellite Healthcare, San Jose, California, United States
- Weinhandl, Eric D., Satellite Healthcare, San Jose, California, United States
- Abra, Graham E., Satellite Healthcare, San Jose, California, United States
- Gopal, Tejas, Stanford University School of Medicine, Stanford, California, United States
- Ordonez, Juan Daniel, Satellite Healthcare, San Jose, California, United States
- Hussein, Wael F., Satellite Healthcare, San Jose, California, United States
Background
Dialysis-requiring hospitalized patients with co-morbid high-acuity needs are challenging to place in outpatient dialysis centers, leading to extended hospital stays. In 2018, we established a program for physician evaluation of high-acuity referrals for admittance to outpatient dialysis centers. The program provides care coordination with the discharging hospital, necessary dialysis-related medical equipment, and training of center staff to manage need for bed or bariatric bed, left ventricular assist device (LVAD), tracheostomy, behavioral issues requiring supervision, infection with communicable organisms, or other high-acuity co-morbid conditions. Little is known about the safety or efficacy of outpatient dialysis for high acuity patients.
Methods
We describe the characteristics and outcomes of patients referred to the program from January 2018 through April 2023.
Results
The program received 468 referrals, of which 149 (31.8%) initiated dialysis at outpatient dialysis centers of a mid-size non-profit dialysis provider. 304 patients were excluded due to reasons including inadequate staffing or space, clinical instability, and overly complex management needs. The most common indications for admission were the need for a special gurney or bed (99 patients), tracheostomy (22), and LVAD (8). The mean (SD) age was 62.7 (14.0) years, 41% were female, and 59% had diabetes. 21% of patients had a central venous catheter at the time of referral into the program. During 152 patient-years of follow-up, re-hospitalization rate at 1 month was 37%, with an admission rate of 2.7 per patient-year and 21 hospital days per patient-year. Despite this, 94% of the patients' survival time was spent out of the hospital. Survival rates at 3, 6, and 12 months were 76%, 71%, and 59% respectively.
Conclusion
A program that utilizes nephrologist evaluation, care coordination, additional equipment, staffing, and training can facilitate hospital discharges and address the care needs of high-acuity patients undergoing dialysis in the outpatient setting. Despite high comorbidity, these patients can benefit from being out of the hospital the majority of their time post admission to the dialysis center.