Identifying Best Practices in Dialysis Care

Abstract

Background and objectives: Because there is wide variation in case-mix adjusted outcomes across dialysis facilities, it is possible that top-performing facilities use practices not shared by others. We sought to catalogue "best practices" that may account for interfacility variations in outcomes.Design, setting, participants, & measurements: This multidisciplinary study identified candidate best practices in dialysis through a staged process, including systematic review, cognitive interviews, and a national "virtual focus group" of dialysis providers. The resulting candidate practices were rank-ordered by perceived importance as determined by mean RAND Appropriateness Scores from a national survey of nephrologists, nurses, and opinion leaders.Results: A total of 155 candidate best practices were identified. Among these, respondents believed dialysis outcomes are most strongly related to 1) characteristics of multidisciplinary care conferences, 2) technician proficiency in protecting vascular access, 3) training of nurses to provide education in fluid management, vascular access, and nutrition, 4) use of random and blinded audits of staff performance, and 5) communication and teamwork among staff. In contrast, there was wide disagreement about the importance of facility-based health maintenance practices, optimal staffing ratios, frequency of dialysis-based physician visits, and optimal frequency of multidisciplinary care.Conclusions: This study provides a "conceptual map" of candidate dialysis best practices and highlights areas of general agreement and disagreement. These findings can help the dialysis community think critically about what may define "best practice" and provide targets for future research in quality improvement.

Discovering the untapped benefits of team nursing in an acute haemodialysis unit of a major teaching hospital

“…There was however a substantial increase in morale when the TNC model was adopted confirming the findings of numerous studies that work group teamwork leads to higher staff job satisfaction, increased patient safety, improved quality of care, and greater patient satisfaction [11,12] . Another study reported that participants' levels of job satisfaction with current position and satisfaction with occupation were both higher when they rated their teamwork higher [13] and these findings suggest that efforts to improve teamwork and ensure adequate staffing in acute settings can improve staff satisfaction.…”

The ‘Centre Effect’ in Nephrology: What Do Differences between Nephrology Centres Tell Us about Clinical Performance in Patient Management?

“…A recent qualitative study of health professionals identified the following beliefs that represent ‘best practice’ within centres providing renal replacement therapy (RRT). These were multi-disciplinary meetings, regular audit, assessment of staff performance, methods of staff communication and staff training to educate patients, but there was less consensus about staffing ratios and frequency of patient review [21]. There are limited data linking structural characteristics within organisations providing RRT and variation in quality of care.…”

Is there “Cherry Picking” in the ESRD Program? Perceptions from a Dialysis Provider Survey

“…This scale was originally developed by investigators at UCLA and the RAND Corporation to evaluate appropriateness of different types of medical care (13,14). It has been used and validated as a measure of provider perceptions of various medical practices (12,15,16). The RAND scale may be trichotomized with the following interpretation: 1 to 3 ϭ "generally low impact;" 4 to 6 ϭ "moderate impact;" and 7 to 9 ϭ "generally high impact."…”

“…IBPiD is a multidisciplinary research effort conducted through the University of California-Los Angeles (UCLA) in collaboration with the Renal Physicians Association (RPA) and the American Nephrology Nurses Association (ANNA) that aims to identify best practices that may improve facility-level achievement of clinical performance measures and overall outcomes in dialysis patients (12). As a part of IBPiD, we conducted a national survey in which we elicited caregiver perceptions regarding the extent and consequences of cherry picking in dialysis care.…”