A subset of patients does not have access to outpatient hemodialysis and relies on emergency-only hemodialysis, which is associated with higher mortality, patient psychosocial distress, physician moral distress, and resource misuse. Thomas Jefferson University Hospital established the Emergency Department Hemodialysis Program to provide scheduled hemodialysis through the emergency department (ED) to patients who cannot access outpatient hemodialysis. This project adapted the program process map, incorporating data from six months of participation to describe the participant experience. The program team identified pathway points of interest, and retrospective electronic health record review was used to extract data on participants, utilization, and visit outcomes. Among 17 participants, the burden of substance use disorder was 29.41%, severe mental health disorder was 29.41%, housing insecurity was 17.65%, and the average Charlson Comorbitdity Index was 5.64 (SD 2.12). Participants spent between 1 and 27 weeks in the program and 78.28% of patient days outpatient. Participants averaged 1.89 (SD .76) pathway visits per outpatient week and 80.60% of participant ED visits resulted in the pathway. The mean length of pathways visits was 10.34 hours (SD 4.56), and length differed between arrival during program hours and outside of program hours (9.85 hours vs 14.23 hours) (t35.716 = -4.019, p < 0.001). These results reflect the need for short-term and long-term hemodialysis homes for a medically and socially complex population. Participants returned for hemodialysis, spending a majority of days outpatient, and most commonly using the ED for the pathway. A multidisciplinary efficiency approach improved timing during intended pathway use.
Ciocco, Francesca, "Process Mapping of the Patient Experience in an Emergency Department Hemodialysis Program" (2023). Master of Public Health Capstone Presentations. Presentation 496.