Hospital alert system improves care coordination at Northwest Kidney Centers

This article is part of NN&I’s 22nd annual dialysis provider ranking. Northwest Kidney Centers is the 8th largest provider in 2016.

For many dialysis patients at Northwest Kidney Centers in the Seattle area, kidney failure is just one of multiple health issues they must manage. And although our excellent nurses, dialysis technicians, dietitians and support staff work hard to educate all patients about caring for their access site, sticking to the kidney diet and managing their blood pressure, even the most diligent can wind up in the emergency department due to an infection, cardiovascular event or something unrelated to dialysis — a stroke, broken hip, pneumonia.

To provide the best care for patients, regular communication is essential. Whatever lands them in the hospital, Northwest Kidney Centers wants to know about it, fast. Now, thanks to a new state-wide alert system, we do.

How it works

The Emergency Department Information Exchange — used at hospitals across Washington state — is an electronic subscription service that facilitates better care coordination between emergency departments and community health care providers like Northwest Kidney Centers.

EDIE collects data from all emergency departments, regardless of varying hospital systems and electronic medical record programs. When our dialysis patients check in, emergency department staff members can instantly see data on all ED visits by that patient in the past 12 months.

Then, just five minutes after a patient checks in to the emergency department, EDIE sends notifications — called EDIE alerts — to Northwest Kidney Centers. This gives us a much more timely, accurate idea of where our dialysis patients are and the additional care they need.

The EDIE alert itself is a fax, sent directly to the specific Northwest Kidney Centers unit (there are 15 in Washington state) where the patient dialyzes. The alert includes the patient’s name, arrival time at the emergency department and the reason for the visit (if provided). It also includes a list of the patient’s other emergency department visits from the past year. When the fax arrives at the dialysis unit, the charge nurse or care manager reviews the data, inputs it into our EMR and follows up with the hospital if need be.

The Washington State Hospital Association launched EDIE, a service of Collective Medical Technologies, as part of an “ER is for Emergencies” campaign. Northwest Kidney Centers pays $6,000 a year to receive alerts.

Quick notification allows Northwest Kidney Centers staff to determine what care the patient needs at that moment, and the list of past visits helps us understand trends so we can form long-term care strategies.

From EDIE to PreManage

As of January 2015, all 15 of Northwest Kidney Centers’ outpatient dialysis units were receiving EDIE alerts for patient visits to the emergency department.

Today, Northwest Kidney Centers also receives a separate faxed EDIE alert — again, directly to the unit where the patient dialyzes — within five minutes after a dialysis patient’s hospital admission. This is thanks to PreManage, an expansion of the original EDIE system. PreManage works independent of network, health plan or hospital — if our dialysis patients are admitted to any participating hospital in Washington state, Northwest Kidney Centers is notified.

After receiving an alert about a patient’s hospitalization, our dialysis staff members can log into PreManage from their unit to view more information about the hospital stay. They can see admission time, diagnosis (if provided) and notes on care guidelines. Northwest Kidney Centers staff members can continue to log back into PreManage to view updates on the patient.

To keep EDIE and PreManage systems current, Northwest Kidney Centers sends up-to-date patient data every 24 hours.

The patient’s nephrologist gets alerts too, helping us all address the “no-show black hole,” when we don’t know where a patient is at appointment time and only later find out that he or she is in the hospital.

Freeing up time, providing more precise information

Thanks to these alerts, Northwest Kidney Centers’ staff members now spend less time following up after missed appointments and have a more accurate understanding of why a patient visited the hospital.

Previously, if a dialysis patient missed a treatment, Northwest Kidney Centers’ staff members would phone the patient’s home to find out why. If they were told the patient was in the hospital, staff would call around to area hospitals until they found the one where the patient was receiving care. EDIE and PreManage have put an end to this inefficient “guess and check” approach.

“We have one patient who’s visited the emergency department more than 70 times this year,” says Deborah Tinnesand, RN, a care manager at Northwest Kidney Centers SeaTac clinic. “Before EDIE alerts, we’d spend a long time on the phone trying to find the hospital she was at. You might think she’d be at the one closest to her house but that’s not always the case — once, she was in a hospital 40 miles from home. EDIE is a huge time saver.

“Also, before EDIE, if a patient had visited the emergency department but didn’t miss a dialysis treatment, we might not find out about the ED visit at all. We would be relying on the patient to fill us in, and they don’t always do that. EDIE alerts leave us much better prepared for when the patient comes back for their next run following a visit to the emergency department.”

Using data for better patient care

EDIE allows the team at Northwest Kidney Centers to focus on patients who go to the hospital often.

From the beginning, the alert system allowed us to track the rate of emergency department visits, and we’d input the data from alerts into our electronic medical record system. But we knew we could do more with it.

Because EDIE alerts provide us with a clearer idea of why patients are in the emergency department, our staff can educate patients — at that important first treatment directly following a hospital visit — about where to go in the future if they encounter the same issue.

To do this, Northwest Kidney Centers developed a questionnaire that care team members use to talk over these future scenarios with patients. We are working to educate patients about when it is appropriate to go to an ED versus calling their primary nephrologist or dialysis unit.

Northwest Kidney Centers’ patients have 11% fewer hospital admissions and 5% fewer emergency room visits than the national average. But the goal is to further lower these statistics, especially reducing the number of unnecessary trips to the emergency department, and EDIE alerts are a useful tool for that.

Improvements could increase impact

Although the EDIE and PreManage systems successfully and quickly notify our staff of patients’ ED visits and hospital stays, there are ways alerts could have an even greater impact.

The depth of information in alerts varies greatly — sometimes they include a detailed diagnosis and other times they just have a patient’s name, date of admission and admitting hospital. If hospitals provided standardized information, regarding diagnosis in particular, data on the alerts would be easier to sort and track. Northwest Kidney Centers is continuing to work with hospitals to audit their systems to see if a more automated, standardized data entry system is possible.

Dialysis providers would also benefit greatly from receiving an alert when the patient is discharged, data PreManage gathers but Northwest Kidney Centers doesn’t receive yet. This would show how long patients were in the hospital and what they were treated for, as well as let us know when we can expect them back at dialysis. If they were to miss their next dialysis treatment, staff would know to follow up immediately to see if they had further complications related to their recent hospital stay.

Internally, we are continuing to evaluate its follow-up procedures after ED visits and hospitalization. But there’s no doubt that even in its infancy, EDIE alerts are helping improve patient care by streamlining communication between area hospitals, Northwest Kidney Centers and nephrologists. This is essential care coordination for some of the region’s sickest patients.

Northwest Kidney Centers wants its patients out of the hospital. But if they’re there, it’s important that staff know when and why. EDIE and PreManage provide that valuable information, helping us track our patients’ care and be better prepared to welcome them back to dialysis following a hospital visit. -by Leanna Tyshler, MD