Caring for your community is your mission. Your patients are your neighbors, family, and friends. As a rural hospital, you are a lifeline to these people — and some of them need dialysis while they’re in your care.
According to the National Institute of Diabetes and Digestive and Kidney Diseases, approximately 35.5 million Americans have chronic kidney disease (CKD), and 2 in 1,000 are living with end-stage renal disease (ESRD), the final phase of CKD. Approximately 68% of the more than 808,000 Americans with ESRD are on dialysis, which they require 3-5 times a week, for 3-4 hours each time. An article published in the Journal of the American Medical Association (JAMA) says, “Patients with end-stage renal disease (ESRD) have the highest risk for hospitalization among those with chronic medical conditions, including heart failure, pulmonary disease, or cancer.” These patients not only are more likely to be admitted, but they also will require dialysis services during their time in a hospital.
Then there are the patients who end up in your hospital with acute kidney injury (AKI). Statistics say that 1% of all U.S. hospital admissions have AKI. During a patient’s stay, the AKI rate rises to 2% to 5%. It also appears in up to 67% of patients admitted to the intensive care unit (ICU). These patients require oversight by a nephrologist and, occasionally, temporary dialysis.
These are the people in your community. They need the specialty care of a nephrologist and, often, dialysis services when they need to be admitted for care in your hospital.
Are You Prepared to Care for Dialysis Patients?
It’s inevitable. As a rural hospital, if you aren’t able to care for patients with ESRD or AKI in your community, they will receive care elsewhere. So, it’s worth asking the question: Are you willing to take steps to provide these patients life-preserving dialysis treatment and nephrology care if they’re admitted? If so, it will likely lead you to several follow-up questions, including:
- Do we have or can we purchase a portable dialysis machine and train staff to use it?
- Do we have a nephrologist on staff or one on call for round-the-clock consultations?
- If we don’t have either, how will transporting or referring them to other hospitals affect our community’s health outcomes —and how much potential revenue will we lose if we are unable to provide this vital service?
Having answers to these important questions is crucial to providing full-service, high-quality care to your community, right there in your community. The good news is that there is a solution: It’s telenephrology — and rural hospitals around the country are taking steps to implement this service for patients in their community.
What Is Telenephrology?
Telenephrology is a service that provides vital remote kidney care consults for hospitals that don’t have an on-site nephrologist or that need support for an existing nephrologist. Telenephrology utilizes standard telecommunications technology to connect nephrologists with your hospital staff who are treating patients who also have kidney disease. Ideally, this service is available 24/7, with a quick response time (within 10 minutes), so you are assured you have access to nephrology expertise whenever you need it.
A successful integration can help your hospital keep care local, improve health outcomes, raise both patient and provider satisfaction, all while lowering the total cost of care and increasing revenue.
Why Telemedicine Is a Good Fit for Nephrology
There are many reasons why it makes sense to deliver nephrology services via telemedicine, especially in the rural care setting. Let’s examine a few of them.
- Telemedicine is much more widely accepted and efficient now. This kind of remote care was less common before COVID-19. The pandemic and the resulting need to keep people safe through physical separation normalized the use of telemedicine. These days, it has become normal practice for clinician-to-clinician consultations in many disciplines to be done via telemedicine. Now, nephrology will be one of them — and it, too, will be covered by the Centers for Medicare & Medicaid Services (CMS).
- Hemodialysis can easily be monitored remotely: A nephrologist doesn’t need to be face-to-face with a patient to assess their condition and recommend treatment. With information provided by your on-site clinical team, such as vitals and lab work, remote nephrologists can provide the team with validation of their treatment recommendations or answer their questions about next steps. The nephrologists can also determine disease progression and calculate risk assessments for kidney failure, an adverse cardiology event, and potentially even mortality. This allows for earlier intervention and faster stabilization of acute patients. It helps guide your providers through treatment and creates better health outcomes for your community members.
- Using telenephrology helps boost admissions for other service lines: These patients aren’t coming in for dialysis; they’re coming in with a broken hip or a heart attack or a respiratory infection, like any other patient. But ESRD and AKI are complex conditions that often present with complications, too. For this reason, these patients frequently require hospitalization due to:
- Cardiovascular issues: Congestive heart failure (fluid overload), coronary heart disease, hypertension emergencies, or pericarditis (inflammation of the heart lining)
- Infections due to a weakened immune system: Pneumonia, sepsis, urinary tract infections (UTIs)
- Electrolyte and metabolic imbalances because failing kidneys can no longer regulate them: Hyperkalemia (life-threatening rise in potassium levels), electrolyte disparities (high phosphorus and low calcium may cause weak bones and fractures), uremic syndrome (buildup of toxins and waste in the blood)
- Other conditions: Anemia, GI issues, bleeding disorders, neurological problems, and complications from pre-existing conditions.
- Telemedicine offers a solution to the nephrologist shortage and rural hospital staffing issues: By partnering with a telenephrology provider, you have 24/7 access to expert nephrology consults. You don’t have to advertise a position, interview applicants, and entice them to move to — and stay in — your rural location. You save on your staffing budget and receive the benefits of a full-time staff nephrologist. Most likely, you’ll have one or two dedicated specialists who become valued members of your team.
- Your nursing team should have easy-to-access training and support: Your nurses will be the main team members providing care for these patients at your hospital. A good telenephrology partner should provide support for them during the implementation process by offering information such as staffing models, competency tools, policies and procedures, and training resources. This will help them learn new skills and feel confident when caring for these patients.
- Patients can be treated locally, reducing the need and the cost of transport: Hospitals spend upwards of $3 billion annually using ambulance, commercial, or private services to transport patients to dialysis services. Using telenephrology, you won’t need to transfer your patients to faraway urban hospitals that offer access to dialysis. You can care for them in-house, right there in your own community.
Telenephrology Makes Critical Kidney Care Accessible Anywhere
Telenephrology makes on-demand clinician-to-clinician nephrology consults a reality, regardless of where your facility is located. You no longer have to turn away patients who are on dialysis because you don’t have a nephrologist on staff. You can admit them and care for them, knowing you have an expert on call and available within minutes.
For more information on how telenephrology can help your hospital stay viable, contact Ron Kubit, CEO of TeleNeph. You can contact him at rkubit@telenephllc.com or at 720.899.4990.