What Does an Onsite Dialysis Team Look Like?

04/22/2023 | Susan Markovich, MBA, RN, CNN, Senior Vice President of Clinical Services

The idea of bringing services to patients, instead of the other way around, is not a new concept. However, since the COVID-19 pandemic highlighted exposure to infection risk when transporting patients to offsite facilities, onsite dialysis at skilled nursing facilities (SNFs) has only seen increased demand.

Dialyze Direct has been providing onsite dialysis in SNFs since 2015. Currently, we serve 175 SNFs in 14 states and counting, a testament to the expertise and resources we bring to the table for SNFs desiring to implement this service at their facilities. Dialyze Direct has developed a robust strategy and a highly skilled team to create exceptional onsite dialysis care.  

This care team is highly capable of both collaborating with the SNFs they are partnered with and delivering only high-quality care to their patients. By bringing a Dialyze Direct care team to an onsite dialysis program, SNFs can have confidence that their population of end-stage kidney disease (ESKD) patients will experience excellent treatment outcomes, and that providers will have the confidence to lean on SNFs within their network for this vital service.

Meet the Dialyze Direct care team

Our comprehensive team of professionals is part of every onsite dialysis program, and our innovative approach to treatment attracts top talent in the ESKD field. Our care providers receive specialized training to address the unique needs of the dialysis patient population, especially geriatric patients. Here are the healthcare experts who provide dialysis care to ESKD patients in our partner SNFs: 

• Nephrologist- this physician is responsible for overseeing all personalized dialysis care and visiting patients either in-person or virtually.

• Registered nurse (RN)- our dialysis nurses must have previous dialysis experience to join the care team, and receive additional training with us to operate the NxStage equipment used in many of our treatment dens.

• Licensed professional nurse (LPN or LVN)- professionals who support nephrologists and RNs in providing care to dialysis patients, including medication administration.

• Patient care technicians (PCTs)- these specially certified technicians can only work on the care team post-certification. They assist the RN to begin and end treatment sessions, and monitor patients throughout, working closely with nurses to execute the plan of care.

• Social worker- an essential part of overall care planning, our dialysis social workers coordinate with SNF social workers to locate the appropriate resources for patients during their course of treatment and post-discharge in the community, including insurance coordination.

• Registered dietician (RD)- dialysis patients benefit from specialized nutritional goals including the correct fluid balance. Our RDs work closely with SNF dieticians to ensure patients’ optimal dietary needs are being met.

How the Dialyze Direct team works with the SNF 

Dialyze Direct’s care is deeply integrated with the SNF, instead of separated. Patients enjoy the benefit of walking to their treatments (if they are able) or simple wheelchair transport, instead of lengthy and expensive transportation to and from an outpatient center. 

Because we offer more frequent dialysis (MFD) in many of our locations, which is provided in shorter sessions lasting less than three hours five times per week (pursuant to a physician’s order), our patients see faster recovery times – with the majority reporting recovery in less than two hours. They experience fewer complications of dialysis and are better able to participate in activities like rehabilitation as well, thus getting them home faster.

To achieve these outcomes, our care team works closely with the SNF to coordinate patient care. There are some key elements involved in this:

• Emergency planning- we share a collaborative strategy around emergency response for patients that may need additional medical support, so that a coordinated process is in place for any significant changes in patient condition
• Patient handoff communication- careful daily patient handoff between SNF personnel and Dialyze Direct nursing takes place to ensure that details like changes in patient condition, new doctor’s orders, vital signs, patient weight and more are all relayed between the SNF and the Dialyze Direct care team
• Monthly lab reports- we share results from patient monthly labs and mid-month hemoglobin testing to reduce the need for duplicate phlebotomy by the SNF and to assist in SNF care planning 
• Shared quality meetings- Dialyze Direct is invited to participate in SNF quality meetings, where data related to patient outcomes, program performance, team communication and more can be collaboratively discussed

How the Dialyze Direct team helps hospital discharge planners

Collaborating with SNFs is only one part of the greater patient care effort coordinated by Dialyze Direct. Prior to SNF admission, we work with the SNF hospital liaisons and hospital discharge planners to facilitate patient placement. Our automated process supports the ability to expedite ESKD patients with subacute needs into SNFs for dialysis instead of hospital discharge planners struggling to find outpatient dialysis placement. 

This includes patients with comorbidities that often exclude them from outpatient treatment, necessitating longer hospital stays. For example, Dialyze Direct is able to accept ventilated and tracheostomy patients in several of our locations throughout the country.

By working closely with SNF hospital liaisons and hospital discharge planners, we are able to quickly identify and accept patients to Dialyze Direct partner SNFs with available beds, reducing the workload for these providers.

How the Dialyze Direct team works with providers

Understandably, external providers need to remain involved in their patients’ care coordination, especially since patients will need to continue their course of treatment with their primary nephrologist post-discharge from the SNF. 

Dialyze Direct recognizes this and works in collaboration with these providers, rather than in competition. Our open-door policy allows primary nephrologists to follow their patients in the SNF if they prefer, and in the event they choose to hand off care to another nephrologist in our program temporarily, we work to coordinate post-discharge follow-up with these providers so that patients can seamlessly return for care after completing their stay in the SNF.

Onsite dialysis with our care team advances treatment for all

This overall exceptionality and ability to work with SNFs, discharge planners and providers is advancing dialysis care for patients and everyone involved in their care. In the process, our care teams improve patient outcomes and reduce costs. Multiple insurers and more than 200 SNFs have trusted Dialyze Direct to help them be at the forefront of dialysis care.

To learn more about how the Dialyze Direct care model can increase quality of care at SNFs, relieve hospital capacity strain and improve patient outcomes, contact hello@dialyzedirect.com or visit www.dialyzedirect.com.

About the Author

Susan Markovich, MBA, RN, CNN is a certified nephrology nurse with more than 40 years’ experience in both critical care and nephrology. As Senior Vice President of Clinical Services at Dialyze Direct, she leads a workforce of regional managers, educators, and clinical services teams across multiple states and locations. Susan is closely involved in the mentorship and development of both clinical and non-clinical personnel and enjoys sharing her knowledge of nephrology nursing with others seeking to improve the lives of patients.