PERFORMANCE IMPROVEMENT STUDY #1

1. Scope of Care

Compliance with hemodialysis treatments

2. Aspect of Care

Missed treatment in the hemodialysis unit can lead to adverse outcomes in the care of patients.  Patients who frequently miss treatments suffer from inadequate dialysis and are more prone to anemia and its complications since they do not received erythropoietin stimulating agents when absent from the procedure. 

3. Plan of action to improve performance

a. Review each shift to determine which patients are missing treatments more than 1 time/month by reviewing February Billing Report

b. Prepare a letter signed by each shift MD to personally advise patient of time missed and risk to health

c. Begin distributing letters to patients when entire team is rounding with MD

d. Present patient education material, "Taking a Vacation" and "Shortened Treatments" handouts to staff at Home Room meeting and assign 2 teammates per shift, (PCTs or RNs) to follow patients

e. Develop posters for waiting area of the "Top 10 Reasons to Come to Dialysis and Complete Full Treatment" in English and Spanish

f. Distribute copy of Billing/Attendance Report  to teammates

g. Homeroom Meetings with shift representatives to follow-up and identify specific pt progress

h. Discuss progress of Attendance Project at CQI each month

4. Fellow involvement

The fellow will attend the monthly Continuous Quality Improvement (CQI) meeting at the DaVita meeting.  This meeting is attended by the medical director of the unit, attending physicians, social worker, dietician, charge nurse, and unit manager.  The fellow will be able to observe how a problem is identified in an outpatient unit and how an action plan is constructed and then implemented.  The fellow will be able to follow the progress of the plan as observe the changes in the identified problem over time.  In this case, improvement in patient compliance with decreased frequency of missed treatments.  This project is a nice example of systems based practice in action.