Quality Improvement Through the Introduction of Interdisciplinary Geriatric Hemodialysis Rehabilitation Care
Received 28 November 2006; accepted 9 April 2007.
Refers to article:
Improving Practice: Reporting Quality Improvement Activities
Katrin Uhlig, Andrew S. Levey
American Journal of Kidney Diseases
July 2007 (Vol. 50, Issue 1, Pages 5-7) Full Text |
Full-Text PDF (60 KB)
Background
Provision of rehabilitation with the aim of restoring personal independence in elderly hemodialysis patients faces several challenges.
Design
Quality improvement report.
Setting & Participants
First 3 years of experience of an inpatient geriatric hemodialysis rehabilitation program in Toronto. Patients with new-onset disability from prolonged illness or an acute event rendering them incapable of living independently.
Quality Improvement Plan
Provision of in-patient rehabilitation with on-site dialysis; a simplified referral system; preferential admission of elderly dialysis patients; short daily dialysis sessions; integrated multidisciplinary care by experts in rehabilitation, geriatric medicine, and nephrology; and reciprocal continued medical education among staff.
Measures
Outcome measures were percentage of patients discharged home, score on the Functional Independence Measure, and attainment of rehabilitation goals.
Results
In the first 36 months, 164 dialysis patients aged 74.5 ± 7.8 years were admitted. On admission, patients had a mean Charlson comorbidity score of 7.8 ± 2.5, 98% had difficulty walking, and 84% required help with bed-to-chair transfers. After a median of 48.5 days, 111 patients (69%) were discharged home; 15 patients (9%), to an assisted-living setting; 20 patients (12%), to a long-term care facility; and 18 patients (11%), to other facilities for acute or palliative care. Of those completing therapy, 82% met some or all of their rehabilitation goals.
Limitations
The program relied on the leadership and drive of key personnel. Discharge disposition as an outcome can be affected by many factors, and definition of attainment of rehabilitation goals is arbitrary.
Conclusion
The introduction of an integrated dialysis rehabilitation service can help older dialysis patients with new-onset functional decline return to their home. Am J Kidney Dis 00:00-00
1Division of Nephrology, University Health Network, Toronto, Canada
2Department of Geriatric Medicine, Toronto Rehabilitation Institute, Toronto, Canada.
Address correspondence to Sarbjit V. Jassal, MB, MD, Assistant Professor, University of Toronto, Staff Physician, University Health Network, 8NU-857, 200 Elizabeth St, Toronto, M5G 2C4 Canada.
ABSTRACT