Hospitalizations and Emergency Department (ED) Visits

• A Change Package to Reduce Hospitalizations
  • A Change Package Quick Start Guide (supporting resource)

Use this change package to support your dialysis facility in reducing hospitalizations, re-admissions, and ED visits. The change package includes actionable strategies, from top-performing dialysis facilities, that can be implemented at the facility level.

• HSAG Root Cause Analysis (RCA) 5-Whys Worksheet—Use the RCA 5-Whys worksheet to help identify root causes of patient hospital use. 
• HSAG Plan-Do-Study-Act (PDSA) Worksheet—Use the PDSA worksheet to assist with implementing a plan to reduce hospital use among dialysis patients.

Use the Reducing Hospitalizations Quality Improvement Activity (QIA) Monitoring forms in the facility’s Quality Assessment and Performance Improvement (QAPI) meetings to track, monitor, and assist with creating an action plan to reduce and address the following top hospital admissions and ED visit diagnoses:

• Anemia
• Bloodstream Infection (BSI) due to Central venous Catheter 
• Fluid Overload 
• Hyperkalemia 
• Hypertension 
• Vascular Access Complications (Hemorrhage and/or Stenosis) 

• Transitions of Care Toolkit—Use this toolkit developed by the Forum of ESRD Networks’ Medical Advisory Council to formulate successful solutions for transitions of care.
• New to Dialysis? Hospital Discharge Checklist—Use this checklist with newly admitted patients to the dialysis facility to help anticipate what to expect with being new to dialysis.
• Nursing Home Staff Education: How to Care for Hemodialysis Patients Outside of Dialysis—Use this informational sheet by sharing it with skilled nursing or assisted living staff to promote optimal care outside of the dialysis facility.
• Long-Term Care Facility Information for Dialysis Residents—Use this reference guide to help keep dialysis patients healthy while living in a long-term care facility. 
• Post-Hospitalization Checklist—Use this checklist for patients discharged from the hospital or ED to achieve optimal continuity of care.
• Sit Down—Don't Stand: Questions About You—Use this patient questionnaire to elicit open-ended responses on how staff can best support a patient to prevent future hospitalizations.   

• How Dialysis Staff Can Impact Hospitalizations—Use the conversation starters in this tool to gather more information from your patients and possibly prevent a hospitalization.
• Where Should We Go for Medical Care?—Use this chart with patients to identify the best place to seek care for a specific symptom, injury or illness. Identifying the best option to seek care can help save time and money.  
• We're Not Being Nosy—We Care! (English / Spanish)
• My Potassium Plan—Use this collaborative resource with patients and their renal dietitian to encourage healthier potassium food choices for better potassium control.
• Vascular Access Appointment—Use this form to remind patients about upcoming vascular access appointments. Appointment reminder can help prevent missed appointments and avoid delays in vascular access creation, revisions, repairs. 
• Communication Tips for Earning a Win—Use this tool to promote successful communication and collaborate between patients and the interdisciplinary team.
• Patient to Patient | Let's Talk About Fluids!—Use this resource to promote healthy fluid balance. Page 16 offers a fluid plan that can be completed through collaboration between the patient and his/her renal dietitian.
• Days Since Last Bloodstream Infection Poster—Use this poster to inform patients, caregivers, and other providers about the last BSI occurrence in the facility. Posting information on infections can promote positive conversations between staff and patients related to infection prevention.

• Monthly Hospitalizations Tracker (Word document)—Use the Monthly Hospitalizations Tracker to track,  trend, and evaluate patient hospitalizations and ED visits and to help establish month to month goals.
• Getting Creative to Break Down Barriers to Reducing Hospitalizations—Use this to resource to help overcome common barriers leading to hospitalization and ED visits. The next time you sit down to talk with your patients, explore and print the various patient and facility resources contained in this resource. 
• Hospital Risk Assessment—Use this tool to help identify patients at risk for hospitalizations. This tool can provide additional insight to unstable and/or patients with new health and/or social issues.

• Take Charge of Your Health: Reduce Unnecessary Hospitalizations—Use this booklet to learn strategies on how to protect yourself from unnecessary hospitalizations.
• We're Not Being Nosy—We Care! (English / Spanish)—Use this list to encourage patients to report important health-related information to staff.
• Play Offense—Avoid Hospitalization—Use this resource to educate your patients about 10 common health risks for dialysis patients and how to protect themselves from hospitalizations.
• New to Dialysis? Hospital Discharge Checklist—Use this checklist with new dialysis patients to help anticipate what to expect from treatments.
• Where Should You Go for Medical Care?—Use this chart to identify the best place to go to get treated for an injury or illness. Identifying the best option to seek care can help save time and money. 
• Chronic Kidney Disease Self-Management Plan—Use this self-management plan to identify actions to take and when to seek help if you are having serious symptoms related to your kidney disease
• Don't Skip—Know the Facts—Use this resource to better understand the risks associated with shortening and/or skipping dialysis treatments.
• Manage Your Diabetes—Use this self-management tool to identify actions to take and when to seek help if your blood glucose is uncontrolled.  
• Your CVC: What You Need to Know!—Use this pamphlet to learn need-to-know information about your central venous catheter.

Reference the resources below for information and tips on managing specific dialysis-related medical issues that commonly lead to hospitalizations and emergency room visits:

• Blood Pressure Zone Tool for Dialysis Patients—Use this self-management tool to identify actions to take and when to seek help if you blood pressure is uncontrolled. 
• My Potassium Plan—Use this collaborative resource with your renal dietitian to identify healthier potassium food choices for better potassium control.
• How to Keep Your Vascular Access Healthy—Use this resource to learn about what to do and what not to do when it comes to protecting your vascular access.
• Your Fluid Intake Matters!—Use this resource to learn about how fluid intake affects you, and strategies on how to manage fluid intake.
• Educate Your Dialysis Patients About Anemia—Use this guide to learn why anemia occurs with chronic kidney disease, how to identify the symptoms, how it is treated, and what you can do to help manage your anemia.
• Patient to Patient | Let's Talk Fluids—Use this resource to promote healthy fluid balance. Page 16 offers a fluid plan that can be completed through collaboration with your renal dietitian.