Frequency of Sit-Down Patient Care Rounds, Attainment of Clinical Performance Targets, Hospitalization, and Mortality in Hemodialysis Patients

Abstract

Abstract. Sit-down patient rounding in hemodialysis units allows providers to focus collectively on each patient's needs and may affect patient outcomes positively. The objective was to examine whether sit-down rounding practices improve patient outcomes in a cohort of 644 adult hemodialysis patients from 75 outpatient dialysis clinics in 17 states throughout the United States who survived at least 6 mo after enrollment (average follow-up, 3.2 yr). Achievement of well-accepted 6-mo clinical performance targets of albumin (Ն3.5 g/dl), hemoglobin (Ն11 g/dl), calcium-phosphate product (Ͻ60 mg 2 / dl 2 ), dose (Kt/V Ն1.2), and vascular access type (fistula); hospitalization rates; and all-cause mortality served as outcomes. Monthly or more frequent sit-down rounds were conducted in 36 (48%) of 75 clinics, representing 287 (45%) of 644 patients. More frequent sit-down rounds were positively associated with an increased chance of achieving the 6-mo clinical performance target for albumin compared with less frequent rounds (odds ratio [OR], 1.88; 95% confidence interval [CI], 1.12 to 3.15); patients who were treated at clinics with more frequent rounds also had nearly twice the odds of achieving more of the five performance targets (OR, 1.95; 95% CI, 1.11 to 3.42). After adjustment for potential confounders, patients who were treated at clinics with more frequent sit-down rounds were 32% less likely to be hospitalized (incidence rate ratio, 0.68; 95% CI, 0.51 to 0.91), had fewer hospital days per year (rate ratio, 0.50; 95% CI, 0.26 to 0.98), and were 29% less likely to die (relative hazard, 0.71; 95% CI, 0.53 to 0.95). Adjustment for some clinical performance targets attenuated the statistical significance of the association with hospitalization. More frequent sit-down rounds in hemodialysis units are associated with better patient outcomes, including an increased chance of meeting the albumin clinical performance target, decreased hospitalization, and decreased risk of mortality. This association may be due to the positive effect of collaborative discussion by the patient care team of short-and long-term care goals for individual patients.It has been postulated that collaborative or interdisciplinary rounds, in which all members of a patient care team discuss each patient's status and develop short-and long-term patient care goals, improve patient care and decrease medical errors in a variety of settings (1-3). However, most of the evidence that such rounds actually improve patient outcomes is anecdotal in nature. Although a few substantive studies of patient rounds and outcomes have been conducted, the results are somewhat inconsistent. For example, in the intensive care unit setting, not having daily physician rounds resulted in an increase in mortality, cardiac arrest, and other adverse outcomes in patients who had undergone abdominal aortic surgery (4), but interdisciplinary rounds were not studied in this setting. One study showed that both cost and length of stay were decreased in inpatient medical wards w...

Association between proximity to the attending nephrologist and mortality among patients receiving hemodialysis

“…Studies should focus on markers that are amenable to intervention, including the type of vascular access 17 and the frequency of sit-down rounds. 10 In addition, the increased use of telemedicine or partnerships between nephrologists and primary care physicians may facilitate closer follow-up of patients with kidney failure who live in remote areas.…”

“…7 We used ArcGIS software (version 9.1, ESRI) to determine the shortest distance by road between each patient's residence at the time dialysis was started and the practice location of their attending nephrologist. [8][9][10] We also classified residence location into the following regions:…”

Associations of Frequency and Duration of Patient-Doctor Contact in Hemodialysis Facilities with Mortality

“…Previous research has suggested that staffing patterns and multidisciplinary rounds may influence patient survival. 18,19 In our analyses, we adjusted for patientdoctor ratio and the patient-dialysis staff ratio at facilities, but not for the quality of care by nonphysician staff. The quality of contacts between patients and staff may also be more relevant than its quantity.…”

Why Is the Mortality of Dialysis Patients in the United States Much Higher than the Rest of the World?

“…Indeed, sit-down rounds are associated with substantially lower hospitalization and mortality rates. 26 Although supportive data are sparse, it seems obvious that factors such as staff numbers, skill sets, and patient contact time would influence outcomes.…”