Facilitating Transition of Care from Hospital Discharge to Outpatient Dialysis Unit

Orlando—The transition from hospital discharge to return to the dialysis unit is a vulnerable time for patients on maintenance hemodialysis. Unsafe transitions put patients at risk for adverse outcomes, visits to the emergency department (ED), and hospital readmission. At the University of Pennsylvania Hospital, 44% of dialysis patients discharged from the hospital had at least one ED visit within 30 days, and 29% of dialysis patients discharged from the hospital were readmitted within 30 days.

Tiffany C. Wong, MD, and colleagues at the University of Pennsylvania Hospital implemented a quality improvement project designed to make the transition of care safer for dialysis patients discharged; the program aimed to facilitate communication between the patients’ primary care physician and the renal consult team, using an automated discharge alert. Dr. Wong et al. reported on the project’s results during a poster session at the NKF Spring Clinical Meetings in a poster titled Improving the Transition of Care of Dialysis Patients Between Hospital Discharge and Return to the Dialysis Unit.

The researchers developed an automated discharge alert in cooperation with the Penn Medicine Center for Health Care Innovation; the alert was sent when the primary care team issued a discharge order for a dialysis patient. The renal fellow then had time to contact the primary care team with possible new recommendations, verify changes in medications, coordinate use of antibiotics, and contact the outpatient nephrologist. The dialysis social worker was also notified to send a discharge information packet to the dialysis center.

Following implementation of the automated discharge alert, sent as both an e-mail and a text page to the covering fellow and as an e-mail to the dialysis social worker, surveys of the receiving fellows demonstrated that 58.3% of respondents were not aware that their patient was being discharged. The alert resulted in 8.3% of survey respondents contacting the primary care team, 8.3% making a new recommendation to the primary care team, and 16.7% contacting the patient’s dialysis center.

The alert was modified to include additional information that included the name and contact information for the outpatient nephrologist and the name and contact information for the outpatient dialysis center. In addition, feedback from the fellows resulted in eliminating the test page and using only e-mail to send the alert; further, the alert was also sent to the outpatient nephrologist. Finally, the automated discharge system was expanded to include Penn Presbyterian Medical Center.

“By using a standardized quality improvement framework, we were able to improve the transition of care for dialysis patients between hospital discharge and return to the dialysis unit. Since development of this automated discharge alert system, our hospital system has switched to EPIC. Future efforts will be focused on developing a new automated discharge alert system within EPIC,” the researchers said.

Source: Wong TC, Gitelman Y, Bausher D, Chaknos M, Negoianu D. Improving the transition of care of dialysis patients between hospital discharge and return to the dialysis unit. Poster presented at the National Kidney Foundation 2017 Spring Clinical Meetings, April 22, 2017, Orlando, Florida.