The home hemodialysis hub: Physical infrastructure and integrated governance structure

Abstract

An effective home hemodialysis program critically depends on adequate hub facilities and support functions and on transparent and accountable organizational processes. The likelihood of optimal service delivery and patient care will be enhanced by fit-for-purpose facilities and implementation of a well-considered governance structure. In this article, we describe the required accommodation and infrastructure for a home hemodialysis program and a generic organizational structure that will support both patient-facing clinical activities and business processes.

Setting Up Home Dialysis Programs

“…A variety of patient home dialysis training approaches have been developed dependent on local conditions, including training within each individual home program facility, centralized hub training with maintenance care at outlying "spoke" facilities, and occasionally training within the patient's home. [18][19][20] Most home programs have staff perform a home visit before acceptance to assess the home environment for any challenges that may need to be overcome to perform safe and effective dialysis (Table 2). This initial home visit is important because it can not only identify issues that need to be addressed in the physical environment of the home but also any care partner or psychosocial support dynamics that may not be readily apparent when the patient is in the home dialysis center.…”

“…A variety of patient home dialysis training approaches have been developed dependent on local conditions, including training within each individual home program facility, centralized hub training with maintenance care at outlying “spoke” facilities, and occasionally training within the patient's home. 18–20…”

Home hemodialysis in children

“…Developing a pediatric home HD program requires careful planning, resources, dedicated staff, and an appreciation of risk and governance issues (for more detailed information, see The Home HD Hub: Physical Infrastructure and Integrated Governance Structure and Infrastructure, Water, and Machines in the Home supplement articles). Programs need to make several important decisions in the planning stage; essential questions that should be asked include the following: What type of dialysis will be offered?…”

Desarrollo y optimización de programas de hemodiálisis domiciliaria basados en modelos TIC

“…En todos los programas de HDD, es necesario que pág. 132 existan estaciones de HD de respiro, para realizar sesiones de HD asistida en determinados momentos, como pudieran ser: pacientes convalescientes tras ingreso hospitalario, pacientes con problemas médicos o técnicos puntuales (como problema en agua, luz o monitor) que impidieran realizar sesiones de HDD habituales, problemas determinados por falta de cuidador en pacientes que lo precisen, dificultades en el funcionamiento del catéter o la fístula de HD, reevaluación de peso seco, necesidad de medida in situ de parámetros de HD,... Para todas estas eventualidades deben existir en los programas de HDD, lo que se conoce por el término anglosajón de "respire days" o "respire care" 70 , los cuales existen en todos los grandes centros que realizan HDD a nivel mundial 71 ; así determinar el tamaño de una unidad de HDD, esto es de las estaciones de HD, no solo supone considerar la cantidad de pacientes que se van a entrenar anualmente en función del número de días de entrenamiento a la semana, sino también tener en consideración espacio para revisar físicamente a los pacientes con la periodicidad que se determine por protocolo o por situación clínica, y la necesidad de un espacio de "respire days" para las circunstancias mencionadas.…”