Total 605 words used.
Project Overview:
This project examines the dialysis care provided to inpatients at a long-term acute care hospital in Jeddah, Saudi Arabia. The dialysis treatment of inpatients at the outpatient dialysis center presents multiple clinical, operational, and financial constraints. These constrains were clearly highlighted through stakeholder interviews, data collection and analysis, and process mapping. A literature review, supported by best-practice interviews, identified the provision of bedside hemodialysis treatment for inpatients as a clinically and operationally feasible option tailored to overcome the identified concerns and mitigate risks. The project addresses the reengineering of the current process, manpower, capital requirements, and the implementation plan.
Proposed solution:
The proposed solution is to establish a new process to provide conventional dialysis sessions for inpatients at the bedside. This shall involve utilizing new technology (portable RO systems), structural adjustments (room modifications to accommodate the systems), new process design, and staff training (to ensure competency).
Rationale:
The proposed solution eliminates all current process risks and pain points. In terms of efficiency, limitations in capacity due to space constrains, waste due to scheduling blocks, and waiting times associated with transport are all eliminated. Patient safety is enhanced due to improved infection control practices, reduced transitions in care, and reducing the risks associated with transport in critical patients. The new process is also more patient centered, where patients shall have better scheduling flexibility, privacy and convenience of having their sessions conducted in their rooms.
Value and Innovation:
The prevalence rate of Chronic Kidney Disease (CKD) in Saudi Arabia is higher than in Western Europe and North America, with over 20,000 patients on hemodialysis (Mousa et al., 2021). There are multiple ways to provide dialysis services for hospital inpatients outside dialysis centers. Henner et al. highlight the possibility of providing bedside dialysis services (2020).
El Shamy et al. expand further on the benefits of the flexibility rendered by home dialysis compared to in-center dialysis in terms of the ability to customize dialysis prescriptions based on patient goals and preferences. This flexibility is associated with better clinical benefits, including blood pressure, volume, phosphate control, and reduced post-dialysis recovery times. There were also notable improvements in patients' quality of life, including improvements in sleep apnea and depressive symptoms (2023). There would be similar benefits in providing inpatient bedside dialysis since customizing prescriptions is possible without having to conform to an in-center scheduling system.
Inpatient bedside dialysis also presents multiple advantages in mitigating infection control risks. Providing hemodialysis treatment for inpatients in an outpatient dialysis center setting is challenging and increases cross-transmission risk. Multidrug-resistant organisms (MDROs) are highly prevalent in long-term acute centers (LTACs), with prevalence rates reaching 80% (McKinnell et al., 2019). Marchaim et al. analyzed 5297 patients admitted to the hospital. They found that LTAC exposure within the previous six months was associated with a significant increase in MDR Gram-negative organisms (2012). Hepatitis B presents another challenge in hemodialysis centers in the absence of a dedicated space for treatment since non-visibly contaminated surfaces are associated with cross-transmission (2001). Providing dialysis to patients admitted at LTACs at the bedside while reducing access to dialysis centers eliminates those risks of cross-transmission.
Another advantage of bedside dialysis is in the Intensive Care Unit (ICU). Repeatedly transporting critically ill patients from the ICU to receive dialysis care in another unit is inherently risky, labor-intensive, and potentially hazardous (Martin, 2009). In addition to the risks associated with physical movement, ICU patients need continuous monitoring and meticulous care which is best provided within the ICU setting.
In conclusion, bedside hemodialysis provides a reliable alternative to dialysis care for inpatients. It is more convenient, associated with improved outcomes, and mitigates multiple risks.
Nomination Title: Establishing an inpatient bed-side conventional hemodialysis service for admitted long term and critical care patients.
