Improved outpatient haemodialysis adequacy using queued schedules

Abstract

SUMMARY Background Although technical advances help achieve haemodialysis adequacy, we hypothesise remediable non‐therapy factors exacerbate patient dissatisfaction, non‐adherence to treatment time and failure to meet dialysis goals. Scheduling inefficiencies lead to the total time in the unit far greater than actual treatment time, impacting facility efficiency and patient frustration. Objectives We used queuing theorem principles to optimise schedules by incorporating timing and workflow for every dialysis process step to design a new schedule, rather than the whole‐shift blocks at baseline. Design The goals were to: (1) craft schedules that maximised efficiency and economics from a facility perspective, and (2) minimise total time in the dialysis unit from a patient viewpoint. As dialysis units are held to a national standard of urea clearance, reduction ratios (URRs) were measured for the 3 months before and after the new scheduling was implemented. Results Dialysis staff and process parameters were measured to craft queued schedules of staggered small groups of patients instead of baseline blocks of 2 large shifts, 24 each. A total of 65 patients changed to groups of 8, with entry‐to‐exit at 290 minutes for four hours treatments. The URRs improved from 72.8 ± 6.9 to 75.2 ± 5.4% (p < 0.001). Before implementation, only 89% of subjects reached the URR facility compliance target of 65%, and afterwards 97% (p < 0.001). Conclusion Queuing theorem principles can be successfully adopted to optimise haemodialysis scheduling. The resultant staggered timing increases facility efficiency, minimises the long wait time dissatisfier, and is associated with improved URRs with more patients reaching target clearance thresholds.

Assessing knowledge of end-stage kidney disease and treatment options in hospitalized African American patients undergoing hemodialysis

“…44,45 To reduce staff strain and improve satisfaction, studies have focused on implementing novel staffing schedules, reducing staff-to-patient ratios, or improving training for dialysis clinic staff. [46][47][48] Several of the changes that interviewees suggested in our study to improve their experience, such as joining a unit affiliated with their preferred hospital or having a clean facility, can be addressed at dialysis initiation when patients "shop" for clinics. However, we found that most of the interviewees in our study were not able to play an active role in selecting which units they received dialysis treatment.…”

“…44,45 To reduce staff strain and improve satisfaction, studies have focused on implementing novel staffing schedules, reducing staff-to-patient ratios, or improving training for dialysis clinic staff. 46–48…”

End-stage renal disease and hemodialysis

“…In addition, Balhara et al16 concluded that missing treatments were commonly due to impaired mobility, higher pain severity, depression, and physical limitations, as well as dependence on public transportation to get to dialysis treatments. Patient nonadherence is exacerbated when inefficient scheduling results in dissatisfaction from the total time in the dialysis unit being well beyond the actual treatment time, which can regularly occur in the hospital setting due to staffing inadequacies and reliance on other departments such as patient transportation and environmental services 17…”

An optimized queue management system to improve patient flow in the absence of appointment system

“…Barghash and Saleet (2018) evaluated the impact of high lateness and no show percentages when setting appointment schedules. Nappo and Ross (2020) propose staggered appointment schedules with small group of patients rather than two big shifts to increase efficiency and minimize wait times. Klassen and Yoogalingam (2019) investigated the effect of adding mid-level service providers (assistants and nurse practitioners) on patient wait time, flow time and physician service time.…”