Does anyone have info./statistics on the growth of home programs within programs? Anotherwards, do current, successful home programs like NW Kidney Center and Lynchburg increase in the number of patients who elect to do home hemo?

Yes, the programs grow. I read on the Renalweb site where a clinic started using NxStage and their growth was 3 fold. I know that at the Rubin Center after introducting NxStage their daily program began to rapidly grow. I Know when we started nocturnal we were the 13th patient and now they are around 30. I do think programs grow and expand after they are started.

From what I’ve seen, the programs are not only growing, but a number of them have lengthy waiting lists to get in!

I’m trying to get ahold of a financial analysis for the “How to Start a Program” section of this site that someone promised me of when to add a new training nurse for a home program to avoid having patients quit their jobs and lose their health plans because they can’t get home treatment in a timely way.

I heard, surprisingly, the premier Lynchburg program has not grown since they started -still have approximately the same number of home patients. My understanding is they use a FR model and do reuse. So, what can be said for why some programs grow and others don’t?

Heather, Keep in mind when it looks like nocturnal programs don’t grow there are a couple of reasons for this. 1 patients get transplanted and out of the programs and replaced by another patient but the number stays the same. Also remember that on nocturnal (and this is what Lynchburg has)
with 1 training nurse not more than 6 patients a year can be trained.
Figure 6 weeks for training 6 x 8 = 48 weeks and that is if you can train one right after another and no one takes longer than 6 weeks. Our nocturnal program seems to go in spurts. Quiet for a while then a few patients all at once. It could also be because more programs are opening up around the area so there are more patients just spread out in more centers. A couple of patients in our nocturnal program transferred to centers closer to their home
when they started programs.

We’d like to see patient training done in small groups (2-4 patients) so that folks who are training have peers, and to speed up the training process so more patients can go home.

I think on Nocturnal that would be very stressful for the training nurse. I also think it would be stressful on the patients. When we first started training on the Fresenius it took me a long time to get set up. If I had to wait when I had a question about the setup because the nurse was helping someone else I would have been nuts by the time the day was over. I also think the patients that catch on faster than others would get a little impatient. I’d like to see patients not have to wait but I’m not sure the group idea would work all that well.

Hi Marty,

Some centers have tried it this way and both the patients and staff say they really liked it, but home patient training is one of those areas where there aren’t really studies about what works best. It may work well for some and not others.

I’d just like to see some “outside the box” thinking about patient training, because it would be hard to justify the salary of a nurse who can train only 6 patients/year, and it’s not good to have people lose their jobs and insurance because they have to wait.

My unit trains patients for home haemo about 4 or 5 at a time, over the 2 sets of days, that’s 8 patients a week for up to 12 weeks. SO they must be training approx. 48 people per year. THen for nocturnal you go in 4-at-a-time, with 2 nurses present for 2 nights, then you’re into it at home.
THe unit currently has over 60 patients. THe charts on the wall they did as part of a study, were done 2 years ago & they had about 30 then.

um…that was me there, being “Guest”


Maybe it would be OK. Our room for training was real small too. Your right though the problems need to be addressed and if you can make the group thing work why not.

That’s a lot of patients being trained for home hemo at your unit. Do the doctors there encourage all the patients to get into home txs?

Yes, pretty much Heather. I don’t know how many in-center patients they have (must be heaps) but basically if you’re not one of the walking dead (well no more so than we are! :lol: ) they’ll try & talk u into Home Haemo. Then while you’re doing that you are asked if you fancy Nocturnal. SO when I quoted the 60 patients, I think that was nocturnal patients…there are still more doing daytime, but I’m not sure how many.
I know at the Xmas party there were about 40 patients, plus their partners, plus staff & they were only a %age of patients, obviously.
THe figures on the laminated posters they have up represented those on ‘the experiment’ that nocturnal is still classed as. :shock:

I knew I had read where someone said that in his country all the able bodied patients were geared towards home hemo and I thought it might be in Aussie Land. This is what I’m talking about. We don’t hear about programs here in the U.S. with so many home patients. Are the patients there required to go home hemo or are they simply encouraged in that direction?

Encouraged. If you are ‘fit and well’…well you know, as far as this applies to us, the ‘walking dead’ :lol:
There are plenty of patients doing in-center h.d., who are either not fit and well enough to do h.h.d. or just do not want to. THere was a guy about my age (but he looked much older! :slight_smile: :roll: ) in there one day, getting a one-off session, as they had a spare bay & the in-center crew had sent him down as he was early. The guy in the next bay asked if he
was starting h.h.d., but he said “No”, as he didn’t want to do it. He didn’t trust his own cleanliness, he lived on his own and he lived within walking distance of the hospital and felt O.K. on his 3 x 5. Fair enough, eh?