Renal Disease Management Across the Continuum
Massachusetts General Hospital/Massachusetts General Physicians Organization
Boston, Massachusetts, USA
Team
David Steele, MD, Medical Director, Outpatient Renal Programs (Co-Team Leader)
Jean Nardini, RN, Nurse Manager, Renal Unit (Co-Team Leader)
Stathis Antoniades, Administrator, ESRD
Amin Arnaout, MD, Chief of Renal Unit
Hasan Bazari, MD, Nephrologist
Chieh-Min Fan, MD, Interventional Radiologist
Michael Gillespie, Administrative Director, Department of Medicine
Tatsuo Kawai, MD, Transplant Surgery
Maria Luongo, RN, Center for Renal Education
John Niles, MD, Nephrologist
Nina Tolkoff-Rubin, MD, Medical Director, Renal Transplant
Gregg Meyer, MD, MSc, Medical Director, Massachusetts General Physicians Organization
Joanne Kaufman, RN, MSN, Case Management
Rick Bringhurst, MD, Vice President, Massachusetts General Hospital
May Chin, RN, MBA, Project Director
Aim
To decrease length of stay by 1.7 days and admissions by increasing outpatient programs to manage vascular access-related problems via a comprehensive Renal Disease Management program.
Measures
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Average length of stay with and without outliers
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Patient days
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Total admits/discharges
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Outpatient vs. inpatient interventional radiology procedures
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Number of patients started on hemodialysis with a catheter vs. an AV fistula
Changes
Implemented comprehensive Renal Disease Management program:
- 2002 Q1: Renal CPM Team launched
- 2002 Q2: Renal Disease Management Model implemented
- 2002 Q3: Practice based NP implemented for pre-ESRD; tracking referrals to Center for Renal Ed; weekly renal
- 2002 Q4: Transplant Surgery joins CPM Team
- 2003 Q1: Dialysis Vascular
- 2003 Q2: Coordinator role shared across CKD, ESRD, and IR; IR vascular access on-site coverage
The Renal Team implemented a multidisciplinary approach to improve the care of patients with chronic kidney disease (CKD) and their unique needs for vascular access once dialysis was initiated. Improvement was measured by the decreased number of ED visits and admissions for vascular-related problems. Inpatient and ED capacity was improved, making increasing patient days for other patients needing tertiary care.
Results
Summary of Results / Lessons Learned / Next Steps
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Top-down support of initiative is essential: Executive sponsorship helped to navigate the cross-disciplinary buy-in to process improvement
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Agreed upon goals and progress reports on reaching goals: Provided direction on whether or not specific interventions had desired result
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Stakeholders: Membership key to getting the job done
Contact Information
May Y. Chin, RN, MS, MBA
Project Director, Clinical Performance Management Program Massachusetts General Hospital
Massachusetts General Physicians Organization
mychin@partners.org
[Storyboard presentation at IHI's National Forum, December 2004]
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