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Welcome to que digo 
conversations in. 

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Nephrology this episode is 
titled how to develop an acute, 

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dialysis care, quality program, 
quality metrics and continuous 

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Improvement. 
Here's your host, dr. 

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Ravi Mehta. 
Developing an acute. 

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Dialysis care quality program, 
is an essential part to improve 

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patient management. 
Hello, and welcome to Katie. 

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Go conversation Nephrology, I'm 
dr. 

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Ravi mantha professor of 
medicine at the University of 

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California, San Diego, and 
joining me to talk about 

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developing acute. 
Dialysis care quality programs 

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is Teresa Martis. 
Pediatric nurse practitioner at 

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a and Robert Lurie. 
Children's Hospital in Chicago, 

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welcome to the program. 
Thank you. 

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It's an honor to be here talking
about quality improvement. 

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Aunt Teresa to start why is 
quality improvement needed for 

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an acute dialysis program. 
I think answering the question, 

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why is always the best place to 
start? 

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And in order to answer the 
question, why? 

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Why is it important for us to 
look at it? 

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Why is providers and caregivers?
Do we care about quality 

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improvement? 
And I think we can look to other

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health care programs, non Health
Care programs to sort of 

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understand that we can look to 
our colleagues who are studying 

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cardiopulmonary resuscitation. 
Qy work. 

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Why do they care about the 
timing of the very first shock 

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from an AED? 
Why do they care about how long 

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it took the team to arrive? 
Why are they studying? 

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The depths of compressions? 
It's because the outcome of that

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Cardiac Arrest, event is about 
more than just getting people to

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the bedside. 
It's about what happens at the 

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bedside non-healthcare, we can 
look to racing. 

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Why do they focus so much energy
studying? 

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Ying practicing and 
understanding what happens in 

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the pit with the pit crew 
because they know the outcome of

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that race is influenced by what 
happens in the pit. 

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So we need to start thinking 
about what we do and how does 

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that influence the outcome? 
What we do know about delivering

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acute. 
Dialysis care is that, it's 

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complex, its technical. 
The patients are very Dynamic 

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and ever-changing but we also 
know that every one of us, Doing

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it a little bit different. 
It's clear in the literature 

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that practice variation is 
associated with poor outcomes, 

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but practice variation also 
limits our ability to understand

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that how we're delivering the 
care what we're doing. 

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When we're prescribing and 
delivering the Care at the 

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bedside influences, the outcome,
it also limits our ability to be

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able to say these are the best 
practices that we should all be 

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doing with the best. 
Comes. 

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So whether you're a neonatal, an
adult or a pediatric acute 

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dialysis program, you need to 
think about applying quality 

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improvement, methodologies that 
include the standardization of 

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practice measuring and analyzing
quality improvement. 

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Indicators identifying areas or 
processes that we could do 

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better because that's when we'll
have a better understanding 

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about how we're caring. 
Patience and how that impacts 

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the patient's outcome Teresa. 
Thank you for pointing out how 

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these high-performance 
organizations look at quality 

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improvement. 
If you were to think about this 

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for a cute dialysis, what are 
the key components? 

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And what would be three common 
indicators that could be used? 

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And more importantly, could you 
tell us a little bit about your 

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program? 
I think when you're getting 

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starting with quality 
improvement program its really 

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twofold. 
First, it's determining your 

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programmatic pieces of your 
acute dialysis program. 

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So that means the structure, 
the, who the what the, where the

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process, the when, and the how 
and the outcome, what was the 

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impact? 
The second piece of getting 

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started, is connecting those 
programmatic pieces to Quality 

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indicators. 
You need them to be both 

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overarching, so looking at your 
program, but also to be 

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relatively Modality-specific. 
For example, you want to have a 

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quality indicator that's 
measuring your process for 

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acute, peritoneal dialysis or 
hemodialysis and specifically, 

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what are the best quality 
indicators measures? 

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Or how do we evaluate that care?
The best quality indicators are 

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relevant. 
They're easy to obtain their 

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easy to analyze and they focus 
on the patient. 

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They also have three common 
characteristics, they focus on 

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safety and sharing. 
We Do no harm, they focus on 

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efficacy ensuring that we're 
delivering what's prescribed and

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they focus on outcome. 
How all of that influences the 

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endpoint. 
An example of a quality 

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indicator for acute programs is 
filter life it applies to all 

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often think of it as associated 
with the CRT but it applies to 

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pert it applies to sled it 
applies to HD because you want 

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to get the maximum life filter. 
So you want to make sure that 

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you're getting the right amount 
of filter time. 

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It's fairly easy. 
It's fairly simple to collect. 

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It's well described in the 
literature There's benchmarking 

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data that's available it focuses
on safety preventing blood loss,

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ensuring that staff are well 
educated and comfortable 

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providing this care. 
If focuses on efficacy. 

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Timely starts, measuring 
interruptions trying to prevent 

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interruptions and it focuses on 
outcomes, reducing 

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complications, ensuring that the
patients getting the deliberate 

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dose and specifically to my 
particular quality improvement 

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program. 
Some of the characteristics of 

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our program is that we truly 
believe that quality improvement

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and acute dialysis is 
multidisciplinary 

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interdisciplinary as well. 
And so we have members from our 

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lab, our Pharmacy, our dietician
Physical Therapy, Social Work, 

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Physicians and nurses. 
From both disciplines critical 

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care and Nephrology we capture 
routinely about 10 quality 

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indicators. 
That are very specific to how 

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we're delivering care. 
So we specifically look at time 

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from order to time to start so 
that we can understand where 

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those delays are. 
We look at solution usage, our 

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committee meets once a month and
we look at the overarching data,

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our activity data are specific 
outliers once a month but then 

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quarterly we present our 
dashboard to all key 

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stakeholders so all of critical 
care. 

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All of nephrology, all of 
Pharmacy, we've been doing 

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quality improvement at for about
10 years. 

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And we have adapted over time. 
We've certainly used indicators 

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to adjust certain things. 
We've dropped indicators that 

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were no longer meaningful for us
and so our program just 

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continues to grow but also 
continues to modify. 

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Thank you Theresa, for those 
just tuning in. 

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You're listening to Katy, go 
conversations nephrology. 

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Today's episode is on how to 
develop an acute. 

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Dialysis quality program quality
metrics and continuous 

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Improvement. 
I'm dr. 

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Ravi Mehta and here with me is 
Teresa martes. 

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So Theresa how did your quality 
program fair in the pandemic and

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what did you have to do? 
So I think the biggest impact 

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that the pandemic had on our 
quality improvement was very 

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similar to what hospitals were 
thinking about and having to do,

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it was about resource 
allocation. 

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So, Just like in the hospital 
they shifted resources to the 

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areas of Greater need. 
We use that same approach to our

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quality improvement program. 
We focused on the things which 

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became necessary to manage in 
difficult times. 

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So we focused on filter life 
because maximizing filter life, 

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decrease the number of filters 
that we were using, which made 

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more available for more 
patients. 

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Decrease, the amount of 
personnel time setting up and 

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tearing down and Starting. 
We also focused on fluid 

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management because we believe 
that if we manage their fluid 

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status, well, we're delivering 
High effective care and maybe be

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able to transition them to a 
different modality. 

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We also really evaluated what 
modalities we had available and 

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what we would need to ensure 
that during this crisis, we 

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would be able to deliver 
high-quality care and what we 

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found was that having this 
robust quality improvement 

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program already, In place helped
us manage through the crisis 

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manage through these difficult 
times. 

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Our quality improvement program,
helped us identify the areas of 

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need and helped us know how to 
shift those resources so that we

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could still provide high quality
Care. 

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That's terrific. 
So before we close, can you 

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share? 
What are the keys to the success

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of a CRT quality program? 
What are the optimal ways to 

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appropriately? 
Create a queue? 

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I yardstick for acute dialysis 
and how are these goals created?

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So that they are realistic. 
I think I'll tackle be the 

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yardstick question first because
I think this time creating a Qi,

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yardstick maybe a little bit 
early in order to Establish 

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realistic goals. 
That requires us to know our 

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data, not just internally but 
externally And I don't know that

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we have enough data to set 
Global or institutional goals, 

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so we need to start with that. 
Yardstick needs to be, comparing

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yourself to yourself the other 
piece of the, yardstick is 

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really understanding, where are 
the resources? 

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What can you use to help you 
build your program and start 

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identifying your own? 
Yardstick add key at Keystone a 

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ton of work and has a ton of 
resources into tools and 

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Publications that you can refer 
to KD go as well. 

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So these are all these projects 
and missions out there that we 

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can use to develop our internal 
tools and then it's about doing 

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collaborative studies. 
And then we will be able to 

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establish that larger Qi 
yardstick. 

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And I think this will become a 
little bit easier as an 

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advancement in the technology 
that we are using. 

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The electronic medical record, 
the newer dialysis machines, 

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dedicated, Qi software improves 
our ability to collect extract 

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and analyze and display data. 
So this allows us again, to 

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shift our resources to actually 
doing interventions and 

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measuring outcomes. 
And to end with the successful 

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quality improvement program, I 
think a successful quality 

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improvement program brings about
substantial Lasting positive 

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change that ultimately improves.
The care that we deliver to our 

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patients. 
The keys to success are 

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dedicated resources. 
Engaged representatives from all

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disciplines. 
Anybody who has their hands in 

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the bucket of care needs to be a
part of your quality improvement

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program and you have to have a 
culture of safety, have to be 

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willing to unapologetically. 
Look at your own data, find your

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own gaps, Create your own 
interventions because that's 

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where it starts, it starts with 
local, and then expands to 

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Regional and then expands 
further than that. 

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That's how we ensure that we are
delivering the best possible 

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care, regardless of what 
institution, that's the 

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foundation of Q, I work. 
Well, that's all we have time 

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for today. 
I want to thank our audience and

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for listening in and thank you 
Teresa for joining me, and for 

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sharing all your valuable 
insights, it was a pleasure. 

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You're speaking with you. 
Thank you so much. 

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I really enjoyed it. 
I'm dr. 

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Ravi mantha to access this and 
other episodes in our series 

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visits que digo dot org slash 
podcast. 

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Thanks for listening. 
This episode of que digo 

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conversations in Nephrology was 
provided by KD go and supported 

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by Baxter Healthcare. 
You're speaking with you. 

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Thank you so much. 
I really enjoyed it. 

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I'm dr. 
Ravi mantha to access this and 

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other episodes in our series 
visits que digo dot org slash 

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podcast. 
Thanks for listening. 

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00:12:43,500 --> 00:12:46,700
This episode of que digo 
conversations in Nephrology was 

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00:12:46,700 --> 00:12:50,700
provided by KD go and supported 
by Baxter Healthcare.