Renal Disease
Conditions
Brief summary
The goal of this pilot is to reduce the 30-day hospital readmission rate for dialysis patients. It is a quality improvement project that consistent of 4 tracks. Tracks 1 & 2: Implement use of checklists of activities for staff to complete when patients are admitted to the hospital, and post-hospitalization with emphasis on fluid assessment, nutrition management, patient coaching, and communication between institutions. Track 3: Work with physicians to develop process to individualize post-hospitalization dialysis orders and improve medication reconciliation. Track 4: Use a renal Care Transitions Case Manager to follow patients in the hospital and 30 days post-hospitalization to facilitate care and patient coaching.
Interventions
None listed
Sponsors
Amgen
Fresenius Medical Care North America
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Chronic hemodialysis patients * All patients admitted to the hospital during the study period
Exclusion criteria
* Patients \<18 years old
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| 30-day readmission rate | Participants will be followed for the duration of each hospital stay and 30 days post-hospitalization, for an expected average of 37 days. | Number of hospitalizations that occur within 30 days after discharge from an initial index hospitalization (convert to percentage of 30-day readmissions). |
Countries
United States
Contacts
Primary ContactRebecca L Wingard, RN, MSN
Backup ContactKathryn McDougall, RN, BSN
Outcome results
None listed