Fast Track Dialysis 2: Improving Protocolized Management of Hemodialysis Patients in an Emergency Department Observation Unit

Abstract

Background

There is little literature comparing efficiency between Hospitalist (HMS) and Emergency Department (ED) clinician management for end stage renal disease (ESRD) patients based on type of observation unit.

Objective

To compare the impact of a communication and triage protocol, Fast Track Dialysis 2, (FTD2) on the primary outcomes of total and ED length of stay (LOS), charges, and observation time of ESRD patients managed by ED clinicians in a closed Type 1 observation unit versus a HMS-run Type 3 unit or ED-run Type 2 unit.

Methods

Retrospective chart analysis of ESRD patients requiring urgent hemodialysis at tertiary and quaternary academic hospitals under an ED managed FTD program versus an HMS managed program and a usual care ED program. Two-sample T-tests were used to compare geographic means.

Results

Respectively, there were 77 and 143 encounters at institutions 1 and 2 in the historical cohort and 161 and 225 encounters in the intervention cohorts. Institution 1 showed a significantly reduced overall LOS (13.2 h vs 10.5 h, p < 0.01), ED LOS (2.9 h vs 2.2 h, p < 0.01), and no difference in charges ($5,642 vs $5,361, p = 0.37). Institution 2 had no significant change in overall LOS (17.9 h vs 17.3 h, p = 0.65) due to significantly increased ED LOS (3.5 h vs 2.4 h, p < 0.01) when implementing FTD2. Institution 2 had a significant reduction in charges ($27,314 vs $8,391, p < 0.01) when implementing FTD2.

Conclusions

Introduction of FTD2 in the ED for ESRD patients is associated with reduced charges and is non-inferior in terms of total observation time.