Welcome to que digo conversations in.
Nephrology this episode is titled how to develop an acute,
dialysis care, quality program, quality metrics and continuous
Improvement. Here's your host, dr.
Ravi Mehta. Developing an acute.
Dialysis care quality program, is an essential part to improve
patient management. Hello, and welcome to Katie.
Go conversation Nephrology, I'm dr.
Ravi mantha professor of medicine at the University of
California, San Diego, and joining me to talk about
developing acute. Dialysis care quality programs
is Teresa Martis. Pediatric nurse practitioner at
a and Robert Lurie. Children's Hospital in Chicago,
welcome to the program. Thank you.
It's an honor to be here talking about quality improvement.
Aunt Teresa to start why is quality improvement needed for
an acute dialysis program. I think answering the question,
why is always the best place to start?
And in order to answer the question, why?
Why is it important for us to look at it?
Why is providers and caregivers? Do we care about quality
improvement? And I think we can look to other
health care programs, non Health Care programs to sort of
understand that we can look to our colleagues who are studying
cardiopulmonary resuscitation. Qy work.
Why do they care about the timing of the very first shock
from an AED? Why do they care about how long
it took the team to arrive? Why are they studying?
The depths of compressions? It's because the outcome of that
Cardiac Arrest, event is about more than just getting people to
the bedside. It's about what happens at the
bedside non-healthcare, we can look to racing.
Why do they focus so much energy studying?
Ying practicing and understanding what happens in
the pit with the pit crew because they know the outcome of
that race is influenced by what happens in the pit.
So we need to start thinking about what we do and how does
that influence the outcome? What we do know about delivering
acute. Dialysis care is that, it's
complex, its technical. The patients are very Dynamic
and ever-changing but we also know that every one of us, Doing
it a little bit different. It's clear in the literature
that practice variation is associated with poor outcomes,
but practice variation also limits our ability to understand
that how we're delivering the care what we're doing.
When we're prescribing and delivering the Care at the
bedside influences, the outcome, it also limits our ability to be
able to say these are the best practices that we should all be
doing with the best. Comes.
So whether you're a neonatal, an adult or a pediatric acute
dialysis program, you need to think about applying quality
improvement, methodologies that include the standardization of
practice measuring and analyzing quality improvement.
Indicators identifying areas or processes that we could do
better because that's when we'll have a better understanding
about how we're caring. Patience and how that impacts
the patient's outcome Teresa. Thank you for pointing out how
these high-performance organizations look at quality
improvement. If you were to think about this
for a cute dialysis, what are the key components?
And what would be three common indicators that could be used?
And more importantly, could you tell us a little bit about your
program? I think when you're getting
starting with quality improvement program its really
twofold. First, it's determining your
programmatic pieces of your acute dialysis program.
So that means the structure, the, who the what the, where the
process, the when, and the how and the outcome, what was the
impact? The second piece of getting
started, is connecting those programmatic pieces to Quality
indicators. You need them to be both
overarching, so looking at your program, but also to be
relatively Modality-specific. For example, you want to have a
quality indicator that's measuring your process for
acute, peritoneal dialysis or hemodialysis and specifically,
what are the best quality indicators measures?
Or how do we evaluate that care? The best quality indicators are
relevant. They're easy to obtain their
easy to analyze and they focus on the patient.
They also have three common characteristics, they focus on
safety and sharing. We Do no harm, they focus on
efficacy ensuring that we're delivering what's prescribed and
they focus on outcome. How all of that influences the
endpoint. An example of a quality
indicator for acute programs is filter life it applies to all
often think of it as associated with the CRT but it applies to
pert it applies to sled it applies to HD because you want
to get the maximum life filter. So you want to make sure that
you're getting the right amount of filter time.
It's fairly easy. It's fairly simple to collect.
It's well described in the literature There's benchmarking
data that's available it focuses on safety preventing blood loss,
ensuring that staff are well educated and comfortable
providing this care. If focuses on efficacy.
Timely starts, measuring interruptions trying to prevent
interruptions and it focuses on outcomes, reducing
complications, ensuring that the patients getting the deliberate
dose and specifically to my particular quality improvement
program. Some of the characteristics of
our program is that we truly believe that quality improvement
and acute dialysis is multidisciplinary
interdisciplinary as well. And so we have members from our
lab, our Pharmacy, our dietician Physical Therapy, Social Work,
Physicians and nurses. From both disciplines critical
care and Nephrology we capture routinely about 10 quality
indicators. That are very specific to how
we're delivering care. So we specifically look at time
from order to time to start so that we can understand where
those delays are. We look at solution usage, our
committee meets once a month and we look at the overarching data,
our activity data are specific outliers once a month but then
quarterly we present our dashboard to all key
stakeholders so all of critical care.
All of nephrology, all of Pharmacy, we've been doing
quality improvement at for about 10 years.
And we have adapted over time. We've certainly used indicators
to adjust certain things. We've dropped indicators that
were no longer meaningful for us and so our program just
continues to grow but also continues to modify.
Thank you Theresa, for those just tuning in.
You're listening to Katy, go conversations nephrology.
Today's episode is on how to develop an acute.
Dialysis quality program quality metrics and continuous
Improvement. I'm dr.
Ravi Mehta and here with me is Teresa martes.
So Theresa how did your quality program fair in the pandemic and
what did you have to do? So I think the biggest impact
that the pandemic had on our quality improvement was very
similar to what hospitals were thinking about and having to do,
it was about resource allocation.
So, Just like in the hospital they shifted resources to the
areas of Greater need. We use that same approach to our
quality improvement program. We focused on the things which
became necessary to manage in difficult times.
So we focused on filter life because maximizing filter life,
decrease the number of filters that we were using, which made
more available for more patients.
Decrease, the amount of personnel time setting up and
tearing down and Starting. We also focused on fluid
management because we believe that if we manage their fluid
status, well, we're delivering High effective care and maybe be
able to transition them to a different modality.
We also really evaluated what modalities we had available and
what we would need to ensure that during this crisis, we
would be able to deliver high-quality care and what we
found was that having this robust quality improvement
program already, In place helped us manage through the crisis
manage through these difficult times.
Our quality improvement program, helped us identify the areas of
need and helped us know how to shift those resources so that we
could still provide high quality Care.
That's terrific. So before we close, can you
share? What are the keys to the success
of a CRT quality program? What are the optimal ways to
appropriately? Create a queue?
I yardstick for acute dialysis and how are these goals created?
So that they are realistic. I think I'll tackle be the
yardstick question first because I think this time creating a Qi,
yardstick maybe a little bit early in order to Establish
realistic goals. That requires us to know our
data, not just internally but externally And I don't know that
we have enough data to set Global or institutional goals,
so we need to start with that. Yardstick needs to be, comparing
yourself to yourself the other piece of the, yardstick is
really understanding, where are the resources?
What can you use to help you build your program and start
identifying your own? Yardstick add key at Keystone a
ton of work and has a ton of resources into tools and
Publications that you can refer to KD go as well.
So these are all these projects and missions out there that we
can use to develop our internal tools and then it's about doing
collaborative studies. And then we will be able to
establish that larger Qi yardstick.
And I think this will become a little bit easier as an
advancement in the technology that we are using.
The electronic medical record, the newer dialysis machines,
dedicated, Qi software improves our ability to collect extract
and analyze and display data. So this allows us again, to
shift our resources to actually doing interventions and
measuring outcomes. And to end with the successful
quality improvement program, I think a successful quality
improvement program brings about substantial Lasting positive
change that ultimately improves. The care that we deliver to our
patients. The keys to success are
dedicated resources. Engaged representatives from all
disciplines. Anybody who has their hands in
the bucket of care needs to be a part of your quality improvement
program and you have to have a culture of safety, have to be
willing to unapologetically. Look at your own data, find your
own gaps, Create your own interventions because that's
where it starts, it starts with local, and then expands to
Regional and then expands further than that.
That's how we ensure that we are delivering the best possible
care, regardless of what institution, that's the
foundation of Q, I work. Well, that's all we have time
for today. I want to thank our audience and
for listening in and thank you Teresa for joining me, and for
sharing all your valuable insights, it was a pleasure.
You're speaking with you. Thank you so much.
I really enjoyed it. I'm dr.
Ravi mantha to access this and other episodes in our series
visits que digo dot org slash podcast.
Thanks for listening. This episode of que digo
conversations in Nephrology was provided by KD go and supported
by Baxter Healthcare. You're speaking with you.
Thank you so much. I really enjoyed it.
I'm dr. Ravi mantha to access this and
other episodes in our series visits que digo dot org slash
podcast. Thanks for listening.
This episode of que digo conversations in Nephrology was
provided by KD go and supported by Baxter Healthcare.