Transforming Care: Insourcing Acute Care Dialysis Services to Improve Patient Care.

Abstract

Background: Quality improvement and cost-reduction efforts among health systems have led to critical evaluation of acute dialysis delivery models.

Objective: To understand the clinical and financial impact of transitioning from contracted third-party (outsourced) dialysis services to health system-owned (insourced) dialysis services.

Methods: Real-world dialysis data at a regional hospital before and after insourcing using the Tablo Hemodialysis System (Outset Medical, Inc) were compared. Previous outsourcing data were compared with data from the first 12 months of insourced dialysis (presented by quarter). Analysis included number of treatments, success of treatments (by clinician determination and by successful fluid removal), and central line (catheter)-associated bloodstream infection (CLABSI) rates. Satisfaction surveys of patients and staff also were collected.

Results: Insourced dialysis achieved higher treatment success, lower CLABSI rates, and high patient and staff satisfaction. Amid a posttransition increase in the number of treatments of 279%, insourced dialysis achieved a 27% increase in treatment success by clinician determination, with more than 97% of treatments considered successful. Successful fluid removal improved from 50.8% to more than 70% across all quarters. The CLABSI rate decreased 72.7% (from 1.1 to 0.3). Retention of dialysis staff was 100% for 12 months. High staff satisfaction with their role in dialysis and insourcing was complemented with high patient satisfaction scores. Capital secured upfront was paid for within the first quarter of insourcing.

Conclusions: Insourcing dialysis with the Tablo Hemodialysis System at a regional hospital markedly improved multiple clinical and financial metrics with high staff and patient satisfaction.