Multidisciplinary Patient Pathways committee reduces avoidable ED admission
ED-administered dialysis treatments decreased by 82% in three hospital systems that adopted a DaVita quality improvement program and tracked ED admissions during a 12-month period.
“We know that ED visits for the [end-stage kidney disease] ESKD population continues to increase year over year,” Jenna Freeman, MSW, a co-author on the study, said. “Patient Pathways offers our hospital partners one single point of contact to manage their dialysis patients from a discharge planning perspective.”
Freeman and colleagues analyzed hospital documentation of avoided admissions and dialysis treatments administered in three hospital EDs during the study period. In each committee, a nephrologist, hospitalist, case manager and Patient Pathways dialysis coordinator collaborated to determine whether dialysis was medically necessary in ED and coordinate care between inpatient and outpatient facilities. The Patient Pathways coordinator helped determine whether ED admission was necessary and educated hospital staff on the definition of avoidable admission, the benefits of avoiding dialysis in ED and admission avoidance processes.
The number of dialysis treatments in each hospital trended downward for four quarters (hospital A: 112, 68, 44 and 12 for quarters one through four, respectively; hospital B: 42, 14, 18 and 14 for quarters one through four, respectively; and hospital C: 30, 14, nine and seven for quarters one through four, respectively). Hospital A documented about 55 ED admission avoidances and about $35,000 in cost savings, and hospitals B and C documented more than 30 admission avoidances and about $20,000 in cost savings.
“Implementation of a program to define and reduce avoidable admissions and unnecessary dialysis treatments in the ED resulted in cost savings to the hospital, reduction of missed treatments in the outpatient setting, and increased the availability of ED beds to patients who lack medical stability,” researchers wrote.
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Benton S.et al. Avoiding admissions and dialysis treatments in the emergency department. Presented at: American Nephrology Nurses Association National Symposium; Aug. 29-31, 2020 (virtual meeting).
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