New service helps patients who already receive dialysis remain closer to home while receiving skilled nursing and rehabilitation care

BROOKFIELD, MO. — Pershing Health System (PHS) has expanded its Swing Bed/Skilled Care Program with the addition of in-house hemodialysis for qualifying patients who are already established dialysis patients.

The new service, which began in August, allows patients who need short-term skilled care following a hospital stay to continue receiving their necessary hemodialysis treatments while recovering at Pershing Health System. PHS has two dedicated dialysis rooms on its Medical-Surgical floor, each equipped with a Tablo Hemodialysis System.

For patients and families, the addition can remove a significant obstacle when deciding where to receive skilled care following a hospitalization.

“Dialysis was identified as the number one barrier among denied Swing Bed referrals we studied,” said Heather Wood, Swing Bed Coordinator at Pershing Health System. “We looked at the types of patients who could not be placed with us and the existing health conditions that were making it difficult for our acute-care partners to find appropriate skilled care. Dialysis consistently stood out as a major barrier.”

Wood brought those findings to PHS senior management, and the organization began working toward a solution. Approximately six months to a year of planning, preparation and staff training ultimately led to the launch of the new service.

“This wasn’t simply a matter of bringing in dialysis equipment,” said Diana Adler, Employee Development/Analytics RN at Pershing Health System. “We wanted to make sure our nurses had the specialized education and hands-on training they needed to provide this service safely and confidently. Our nurses are trained and certified in the use of the dialysis machines as well as initiating vascular access for the patient’s treatment.”

Dialysis as Part of a Patient’s Skilled Care Stay

The new service is specifically for patients admitted to Pershing Health System’s Swing Bed/Skilled Care Program who have an established need for hemodialysis.

PHS is not currently providing dialysis for acutely ill patients who require acute dialysis services, nor is the new program intended to function as an outpatient dialysis center.

Instead, it allows a qualifying Swing Bed patient who already receives dialysis to continue that necessary treatment while at Pershing for another skilled-care need.

For example, a patient may spend three or more acute inpatient midnights in a hospital while being treated for a serious illness such as sepsis. Although the acute illness may improve enough for the patient to leave acute hospital care, the patient may still be too weak to safely return home and may need skilled nursing and rehabilitation to regain strength and independence.

If that patient also receives regular hemodialysis, PHS can now potentially provide both the qualifying skilled services and the patient’s necessary dialysis during the Swing Bed stay.

The concept is similar to caring for other ongoing medical conditions during a skilled-care admission. A patient with diabetes, for example, may be admitted primarily for rehabilitation following an illness or injury, but the patient’s diabetic medications and blood glucose still need to be managed throughout the stay. In the same way, an established dialysis patient’s hemodialysis can now be incorporated into the overall care provided during a qualifying Swing Bed stay.

Patients must meet the requirements for admission to the Swing Bed/Skilled Care Program. This generally includes a qualifying acute hospital stay of at least three consecutive inpatient midnights and a continued need for a qualifying skilled service, such as skilled nursing or rehabilitation.

Removing a Major Barrier to Care Close to Home

Before PHS added in-house dialysis, an established dialysis patient could potentially receive Swing Bed care at Pershing, but transportation to and from an outside dialysis center had to be arranged by the patient’s family.

For a recovering patient who may require dialysis two or three times each week, that could mean repeatedly leaving the hospital, traveling to a dialysis center, completing treatment and then traveling back to Pershing.

It could also mean missing time from rehabilitation and other skilled services. For some patients and families, the logistics of transportation could make receiving skilled care close to home impractical.

In other cases, a patient might have to remain in a larger city or community for skilled care simply because dialysis was available there. Some patients could also face returning home before they were physically ready because finding a skilled-care provider able to accommodate their dialysis needs was difficult.

With dialysis now available as part of an eligible Swing Bed stay at PHS, those patients have another option.

“Our goal has always been to help our local citizens get back home from an acute-care setting where they can be closer to family, friends and their community while they continue recovering,” Wood said. “Now, needing dialysis doesn’t automatically create the same transportation or placement barrier for someone who otherwise qualifies for our Swing Bed Program.”

The benefit extends to family members and caregivers as well. Eliminating multiple trips each week to an outside dialysis center can reduce the transportation burden on families while allowing the patient to remain in one location for skilled nursing, rehabilitation and other necessary care.

“Recovery from a serious illness can already be physically demanding,” Adler said. “Being able to provide the patient’s dialysis here means they don’t have to leave Pershing several times a week for treatment and then return to continue their skilled-care stay. It allows us to coordinate that necessary dialysis treatment with the other services that are helping the patient become stronger and prepare to return home.”

Two Dedicated Dialysis Rooms and Specially Trained Nurses

Pershing Health System has two dedicated dialysis rooms located on the Medical-Surgical floor. Each room has its own Tablo Hemodialysis System, allowing PHS to accommodate up to two qualifying Swing Bed patients receiving dialysis at a time.

Hemodialysis treatments are provided by specially trained PHS nurses. Nurses providing the service have completed specific training in the use of the Tablo system and are certified in use of the dialysis equipment and initiating vascular access for treatment.

Dialysis care is provided with nephrology oversight, including Boone Health nephrologist Dr. Schiavo, along with PHS hospitalist involvement.

“This is very much a coordinated approach to care,” Adler said. “Our nurses provide the hands-on care at Pershing, but the patient’s dialysis treatment is guided by the nephrologist. Each patient’s needs are reviewed individually, and the nephrologist determines the appropriate dialysis orders while that patient is receiving skilled care with us.”

When a patient is referred to PHS for Swing Bed care, the patient’s medical and dialysis information is reviewed as part of the admission and care-planning process. Information is received from the sending facility, and dialysis orders at PHS are determined by the nephrologist based on the individual patient’s current medical needs.

Treatments can be provided as frequently as ordered by the nephrologist. PHS uses information about the patient’s established dialysis schedule from the dialysis center and sending hospital when coordinating care. For many patients, dialysis is typically required two to three times per week, although the frequency is determined by the nephrologist.

When the patient is ready to leave Swing Bed care, appropriate discharge information is provided to the patient’s regular dialysis center to assist with a smooth transition back to outpatient dialysis services.

Helping Patients Return to Their Home Community

Although one of the primary goals is to better serve residents of Brookfield and surrounding communities, PHS can receive Swing Bed referrals from acute-care hospitals throughout Missouri.

The referral and admission process has not changed because of the addition of dialysis. Patients are admitted to the Swing Bed Program based on their qualifying skilled-care needs, not simply because they require dialysis.

A patient must be medically stable and appropriate for the level of care available at Pershing Health System. Patients who are acutely ill and require acute dialysis or a higher level of medical support are not candidates for the service at this time.

For patients who do qualify, however, the addition of hemodialysis may make it possible to return to their home community sooner rather than remaining farther away solely because they require ongoing dialysis.

Referrals are handled hospital-to-hospital so PHS staff can review the patient’s condition, skilled-care needs and dialysis requirements and determine whether the patient can safely and appropriately be admitted to the Swing Bed Program.

PHS began providing the service in August and is already caring for its first Swing Bed patient utilizing in-house hemodialysis three times each week.

“Being able to offer this service is about looking at the whole patient,” Adler said. “Dialysis is an essential part of care for these patients, but it doesn’t have to prevent them from receiving the rehabilitation and skilled nursing services they need closer to home. Our team has worked hard to prepare for this, and we’re excited to be able to provide another level of support for our patients and their families.”

For Pershing Health System, the addition represents another step toward addressing gaps that can prevent rural patients from receiving the care they need close to home.

“Sometimes it isn’t the patient’s primary skilled-care need that prevents them from coming back to their community,” Wood said. “It can be another medical need, such as dialysis, that makes placement difficult. We wanted to find a way to remove that barrier while still providing safe, appropriate skilled care.”

With in-house hemodialysis now available for qualifying Swing Bed patients, Pershing Health System can help more recovering patients receive the skilled services they need while remaining closer to the people and community that are part of their recovery.

For more information about Pershing Health System’s Swing Bed/Skilled Care Program, call 660-258-2222 and ask for Heather Wood.