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Home hemodialysis saves patients hours of time

Prior to the fall of 2013, medical transport teams taking frail patients by gurney to off-site dialysis treatment were part of the daily routine at Hill Haven Transitional Care Center in Webster. 

The trek would begin in the wee hours, after nurses roused patients from their warm beds, dressed them and sent them down the corridor, into the elevator and up the ramp of a vehicle idling outside.

Upon arriving at the dialysis unit, a handful of staffers would get a sling lift to position each already rattled patient into a chair for the three-hour procedure. The early pickup meant missing breakfast, so sandwiches and meal replacement drinks had to suffice before the return slog began.

Determined to improve patient satisfaction and streamline care, employees at Hill Haven—an affiliate of Rochester Regional Health System—began brainstorming several years ago about how to deliver hemodialysis treatment on-site. When space limitations derailed the plan to offer the procedure in patients’ rooms, staffers recommended establishing a suite where a home hemodialysis model could take root.

Today, Hill Haven’s hemodialysis suite operates 12 hours a day, six days a week.

“We have a two-chair or two-bed unit where (patients) just get pushed through the hallways into their treatment, rather than getting into an ambulance, being transported in this freezing cold weather,” said Marie Wade R.N., director of dialysis services at Rochester General Hospital.  “I mean, this year is a good example, just by itself.”

Besides introducing various efficiencies, the program has spared patients from out-of-pocket transportation costs and helped their families stop worrying about the risk of injury during trips to and from treatment.

Health care regulations in place before the hemodialysis program’s launch permitted Hill Haven to offer peritoneal dialysis, which involves using the membrane lining the abdominal cavity as a filter to clear waste and extra fluid from the body. That treatment usually takes place on a nightly basis and does not require traveling to a dialysis center.

“But not all patients can do that type of dialysis,” Wade said. Excessive abdominal scarring and a predisposition to infection are among the reasons patients turn to hemodialysis, which typically must be done three days a week for roughly four hours each time.

“When you think about transporting (patients) … they’re gone for a long time,” Wade said.

As baby boomers move closer to heightened risk for kidney disease, the demand for dialysis services is climbing.

According to the Centers for Disease Control, more than 20 million Americans may have some degree of chronic kidney disease. The condition is most prevalent among adults older than 70 and does not have specific initial symptoms.

Diabetes and hypertension are the leading causes of kidney failure, a severe illness also known as Stage 5 CKD or end-stage renal disease. Patients at that stage require dialysis or a kidney transplant to survive.

African Americans are about three and a half times more likely to develop end-stage renal disease than whites. Hispanics are about one and a half times more likely to develop the condition than non-Hispanics.

Still, CDC data show kidney-failure cases declined roughly 2 percent in 2011 over 2010, marking the first decrease in more than 30 years and suggesting that patients may be getting better treatment.

Besides offering dialysis patients a better quality of life, the Hill Haven program aims to support the migration of outpatient services from hospitals to more convenient, accessible and cost-effective community locations.

“Other hospital systems could do it because now we’ve paved the way,” Wade said.

Sheila Livadas is a Rochester-area freelance writer.

3/20/15 (c) 2015 RBJ Health Care Achievement Awards. Rochester Business Journal. To obtain permission to reprint this article, call 585-546-8303 or email rbj@rbj.net.


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