Discharge Planning Advisor

Sutter Health seeks dialysis solutions

Long stays expensive, risky

One of the biggest discharge planning challenges at Sutter General Hospital in Sacramento, CA, involves patients who need dialysis after they come into the hospital, says Kate Tenney, RN, manager of case management.

These might be people who didn’t need dialysis before but have renal failure during the course of the hospital stay, she explains, or they might be dialysis patients who were refused care in a dialysis unit because of noncompliance.

In some cases, there are no dialysis chairs available in the community, Tenney adds, or the person can’t tolerate sitting in a chair and needs to lie down during the procedure. "They will stay for months at a time because of the need for dialysis, and no skilled nursing facility [SNF] to send them to."

The issue, says Barbara Leach, RN, director of case management for Sacramento Yolo Sutter Health, is that "the patient has no ability to sit up and [be transported] to dialysis. They can’t go to a SNF because of their inability to do outpatient dialysis."

"The rule is they can go [to a SNF] if they can get up out of a wheelchair and walk to the dialysis chair and then get back up," adds Tenney. "But probably the biggest problem is patients who have been banned from treatment [at dialysis units] because of noncompliance."

Not only are dialysis patients among the most expensive patients to keep in the hospital, Leach says, but the prolonged stay is detrimental to their condition.

"There are huge risks to being in the hospital unnecessarily," she points out. "The longer you stay in bed, the more debilitated, the more exposed to other injuries you become."

Leach and Tenney are seeking a solution to the problem and would welcome feedback from colleagues at other facilities who may have dealt with the same situation.

"We’ve talked to a local SNF about building dialysis units within their [facility] that we would help them set up," says Tenney. "We had hoped to take a couple of rooms and to provide them with staff and chairs, but the state has laws around whether or not you have a dialysis unit in a facility, and you can’t get reimbursed for it under the current laws."

Another option that is being pursued, she notes, is getting licensing for a freestanding dialysis unit next to the facility that would have both chairs and beds.

While Sutter Health is not going so far as to try to change the law, Tenney says, "we did say we would be happy to participate on any level if they were running into barriers and needed us to step in and testify.

"Eventually, we hope the [state] will look into [changing] the law, because they are paying for these patients to stay in the hospital," she adds. "It’s in their best interest to make this a priority."

This kind of activism on the part of health care organizations is a new trend, Tenney suggests, born of the need to make the most efficient use of limited funds.

"Hospitals more and more are going out to the community and saying, Let’s work together to create something [because] this is impacting our hospital and our community," she adds. "I think this is a shift. In the past, [a hospital] would not be so involved."

[Editor’s note: If you have feedback on this issue, please contact Discharge Planning Advisor editor Lila Moore at (520) 299-8730 or by e-mail to lilamoore@mindspring.com.]