Sensing Savvy

As a dialysis provider, you know that healthcare settings and patient conflict go hand in hand. But unresolved patient conflict creates more stress for your staff, decreases productivity and teamwork and harms your clinic’s ability to safely deliver top-quality dialysis care.

Despite these consequences, providers often shy away from confronting challenges with patients because conflict is almost always uncomfortable. Experts call this avoidance a lack of “conflict competence,” and cite it as a major reason for dysfunctional dialysis units.   

How a patient feels during his or her dialysis treatments often affects whether he or she will return to your clinic for further treatment. The National Kidney Foundation recommends patients evaluate the staff of a dialysis clinic before choosing a provider. The organization advises patients to see if the staff makes them feel welcome, if they were helpful, knowledgeable and were able to answer their questions. Patients also are encouraged to notice if clinic staff listens to them and addresses their needs.

Patients want to feel understood and at ease, and if your clinic is struggling to retain patients, this could be a contributing factor to patient retention.

Thankfully, a few changes in the way your staff communicates can improve patient experience at your dialysis clinic.

Clinicians at a Fort Worth vascular access center wanted to ascertain the effects of banding their patients with high-flow arteriovenous fistulas. It is known that patients with high flow of more than 2 L/min are more likely to experience cardiac symptoms. Therefore, the nephrologists set a goal of reducing flow in the high-flow fistulas of 12 patients to between 600 and 1200 mL/min and then retrospectively analyzing the results.

“I love this machine!” exclaimed Dr. Inés Aragoncillo when a slide displaying the Transonic Hemodialysis Monitor, was shown at the recent American Association of Nephrology (ASN) convention in Chicago. Dr. Aragoncillo was presenting the findings of her three-year RCT in which she and her colleagues studied the addition of ultrasound Doppler and ultrasound dilution (Transonic) surveillance to classic vascular access monitoring in their hemodialysis patients.

Providing excellent patient care should be the top priority for all dialysis clinics. Minimizing pain, making patients comfortable, and treating them with compassion creates a respectful experience during a difficult, tedious process. But that can be easier said than done, especially if clinics have problems with leadership, staff and patient communication. If clinics don’t address issues such as lack of professionalism, low staff morale and patient safety, they risk losing patients and money. Below are five effective ways clinics can improve the dialysis patient experience.

A study published in PLOS ONE in March 2017 by clinicians from Huazhong University of Science and Technology in Hubei, China, investigated the association between AVF flows and inflammation, cardiovascular events and deaths in Chinese hemodialysis patients who have a radio-cephalic fistula (AVF). They recognized that AVF flows impact dialysis adequacy in hemodialysis patients. But there was limited data for different access flow levels on outcomes related to long-term dialysis Chinese patients.

The KDOQI Work Group and Dr. Michelle L. Robbin from the University of Alabama at Birmingham, offer valuable guidelines for successful hemodialysis cannulation of fistulas in end-stage-renal-disease (ESRD) patients. It is recommended that a 4 mm or greater vessel diameter and flow of 500 mL/min or greater is needed to support successful hd cannulation and dialysis blood flow rates. Ultrasound is not needed for cannulation. Also suggested is the following Rule of Sixes:

NKF-KDOQI guidelines recommend that the vascular access flow assessment be performed during the first 90 minutes of hemodialysis to eliminate error caused by decrease in cardiac output or blood pressure related to ultrafiltration and/or hypotension. This measurement time restriction to within the first 90 minutes limits the number of measurements that can be performed by one operator, which is a significant issue in clinical practice.

Children undergoing hemodialysis present unique challenges for dialysis providers. Hemodialysis in children presents challenges: Little is known about their ideal vein and artery sizes, maturation times and expected volume flow rates to achieve a functioning fistula.

After clinicians at London’s Great Ormond Street Hospital for Children reviewed the outcomes of 25 children who received an arteriovenous fistula (AVF), they found that five had primary AVF failure, and three had secondary AVF failure.

Two of the most common options for treating a vascular access stenosis in hemodialysis patients are percutaneous transluminal angioplasty (PTA) and fistula reconstruction/revision surgery. Because it is more convenient, PTA has become preferable to surgical revision.

To examine the efficacy of and compare percutaneous transluminal angioplasty or surgical repair, clinicians from three hospitals in Taiwan investigated the duration of fistulas and maintenance costs for dialysis patients. Their study was published in the 2017 February issue of the Journal of Vascular Access.

In the study, charts were reviewed retrospectively from 544 hemodialysis patients from two dialysis units in a teaching hospital in the southern area of Taiwan. Researchers analyzed the frequency of PTA or revascularization surgery and the use of related medical resources.