SHM Converge Scientific Abstract ePoster Gallery-Admitted Patients Without Hemodialysis Center: Can They Be Safely Discharged?

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This project addressed a growing shortage of outpatient hemodialysis (HD) chairs, which had led to prolonged hospital stays for patients awaiting dialysis placement or unsafe discharge without reliable access to treatment. At Thomas Jefferson University, the average hospital stay for these patients was 22.6 days in 2022.<br /><br />To improve access and reduce unnecessary admissions, the team created an Emergency Department–based hemodialysis pathway (EDHD). The program used a structured enrollment process, electronic health record flags, standardized discharge instructions, and monthly multidisciplinary review meetings involving emergency medicine, internal medicine, nephrology, nursing, and placement specialists. Patients eligible for the pathway were ambulatory, cognitively intact, had stable vital signs, reliable transportation, and could tolerate variable treatment schedules.<br /><br />From July 1 to December 31, 2022, 22 patients were enrolled. Half (11 patients) obtained a dialysis chair assignment, 3 (14%) were lost to follow-up or discharged from the pathway, and 8 (36%) were still waiting, including 5 unlikely to be placed because of repeated regional denials.<br /><br />The program appeared feasible and efficient. Average time from arrival to renal consult was 57 minutes, and average total time from arrival to discharge was 9.5 hours for patients arriving in the recommended window. The program may have avoided up to 328 excess hospital days. Encounters increased over time while admission rates stayed low. Financially, the first 3 months showed a positive contribution margin of $86,634.<br /><br />The patient population was highly vulnerable, with high rates of racial/ethnic minority status, homelessness, substance use disorder, and serious mental illness. Main barriers to adherence included transportation problems, complex comorbidities, homelessness, and patient preference. Overall, the study suggests ED-based HD can be a safe, cost-effective bridge for patients lacking community dialysis access, while broader systemic solutions remain needed.

Asset Subtitle

Rebecca C. Jaffe

Meta Tag

Author List Carla Palomino, Jennifer White, Lakshmi Ravindran, Muhammad Ahsan Rasheed, Omar H. Maarouf, Rebecca C. Jaffe, Zulfi Husain

Category Innovations

Concept Emergency Department Hemodialysis Pathway

Concept Hemodialysis

Concept Outpatient Dialysis Access

Concept Chair Assignment

Concept Social Determinants of Health

Distinguished Non-Finalist

Presenter Organization Thomas Jefferson University

Presenting Author Rebecca C. Jaffe

Track Quality Improvement

Keywords

hemodialysis

emergency department

dialysis access

outpatient dialysis

hospital length of stay

renal consult

patient placement

care pathway

transportation barriers

cost-effective intervention

Emergency Department Hemodialysis Pathway

Hemodialysis

Outpatient Dialysis Access

Chair Assignment

Social Determinants of Health