Should dialysis be connected to hospitals? I think that dialysis should work just like any other life needed service. How and why this has not happened before now is not important. The only way I see that consumers/patients will get what is needed is if the centers stay open 24/7. I see myself as a consumer first. It’s sad that I don’t have as many choices in my doctors and medical services as I do in other parts of life. I heard a doctor complain that us americans are so backward in our understanding of medical things. Well give us the choices to go to where forward thinking people work and while they are at it, let’s see if we can make the trip in under a day.
In my other post I mispelled consumer ,sorry on that.
bobeleanor :oops:
There have always been a few clinics that ran more shifts into the evening and years ago I talked with a social worker in a dialysis clinic that ran 24/7. At that time, people on the night shifts were the “street people” from what she told me.
Interestingly, some clinics are now running 24/7. They’re doing nocturnal in-center dialysis overnight. There is an FMC clinic in Kansas City where I am that does this. I spoke with a nurse recently about it. She was very enthusiastic about it both for the staff and for the patients. This trend may grow as clinics realize they can dialyze a new different shift of patients and have 100% utilization on their machines. This may be one way to deal with the growing number of people needing dialysis instead of spending lots of money to build new clinics and buy new machines for them.
Personally I’d rather see more patients doing home dialysis than seeing dialysis clinics running 24/7…unless dialysis clinics start doing a better job of empowering capable patients to participate more in their treatment. I don’t want to see any more patients who could do home dialysis if they knew about it quitting their jobs and becoming dependent on clinic staff.
This is how it works where I live. All the dialysis centres, both acute, and chronic and, the many satellite ones as well are part of the main regional hospital, although they are in a variety of different hospital campuses. It seems like a good system to me.
Pierre
In the U.S., dialysis started out always being provided in hospitals. Back in 1978 when I started working in dialysis, it was in a university affiliated hospital-based dialysis clinic. Over the last 20 years or so, the number of hospital-based clinics has been dropping. Even though clinics are not considered “hospital-based,” some “free-standing” or “non-hospital-based” dialysis clinics are located in hospitals (renting space) or near hospitals. There are even some dialysis clinics that are connected to skilled nursing facilities.
This is the way we work in Australia too. My clinic is attached to a small regional (country hospital) They use both Fresenius aand Gambro machines for home patients and I am amazed at the service they provide for patients in far flung isolated areas. There is never any talk/burden of costs to the patient, just what is best for each individual. The in centre dialysis is 5 hoursx 3, open for 6 days. If people want more dialysis and they are capable, they are encouraged to try home dialysis and are assisted with accommodation and travel while training.
It would be great even to have someone you could phone after hours if you need help. At the moment we can phone the HD unit up until 11pm. Then theres always the acute unit, but they dont always know what your talking about, if your a home patient. And then theres emergeny, they dont know anything about home HD :?
That sounds very sus on the part of your home training unit. I live in country NSW and I have a pager no. to ring 24/7 where one of the training nurses will call back immediately any time.
What reason would you have to phone after 11 PM? If it’s a medical problem significant enough to phone, you don’t want dialysis but rather emergency. If it’s a technical problem with the machine, or some event like a blood leak, etc., you just take yourself off and call in the morning. The problems people have are mostly when setting up, and after a while of doing this stuff at home, you end knowing what to do for almost any situation.
Pierre
I’m on the east coast of usa. And I when I started dialysis(12/01/05) it was in the hospital. Then I was dropped into a center. As far as I know most hospital have acute dialysis room or rooms. But you only stay in them as long as needed, then off to the center. Beth can you tell me why is dialysis treated different than other medical problems? I have spina bifida and am 49 yrs. old. I have taken care of myself since my preteens yrs. I lots of trips into hospitals over the yrs. But I was under the idea that if you could care for yourself then you did. This whole thing was a shock to see people who seem very able to do that. Why would the gove’t or insurance pay if people would be able to care for them selves? I don’t want to hard or cold it just the way I’ve done things. I understand that some may not have the space or a helper, but fear should not be the reason. I mean no disrespect to anyone who sees this I’m just looking for honest anwsers. I’ m home now doing my own txs.
I agree, but to have that extra security, particularly when you live in an isolated area, as many of us Aussies do, sure gives you peace of mind, particulary in those first few tumultuous months.
However, my main point would be here in Aussieland (as i believe in Canada) we are all given the same access and care under our Public Health system, so if I have this added security of the 24 oncall number, then so should Amba and everyone else in Oz.
Beth can you tell me why is dialysis treated different than other medical problems? I have spina bifida and am 49 yrs. old. I have taken care of myself since my preteens yrs. I lots of trips into hospitals over the yrs. But I was under the idea that if you could care for yourself then you did. This whole thing was a shock to see people who seem very able to do that.
Believe me, I’ve been trying to figure this out for almost 30 years. There are many things that foster a sense of dependency in people on dialysis. Here are some of the ones I can think of off the top of my head:
– People on dialysis are told from the start by Social Security that not only can they get Medicare, but they are eligible for disability benefits simply because they have kidney failure. They don’t have to prove a need or provide medical justification beyond the form that shows they started dialysis.
– Staff do all aspects of care for patients from Day 1 because they believe patients are not competent to do it, don’t want to/can’t learn to do it, won’t do it right, etc.
– Patients are not encouraged to take control and learn to do as much of their treatment as they can. In fact, those that try are often discouraged by staff who don’t want to give up control.
– People are never told about home dialysis because the staff at their clinic don’t know about it and their doctor doesn’t believe in it.
– Some people like to have others take care of them and don’t believe they are capable or would do as good a job taking care of themselves as the staff at their clinic.
I’m sure there are others. Anyone else want to add anything they’ve observed?
I would add, far too many nephs are machine illiterate and staff are only minimally trained (a college degreee is not required in this specialty and company training may last only as long 2-6 weeks) -the objective seems to be profitiability as opposed to quality patient care.
Imagine this- the neph does not have to know how the machine operates. To me, that means that the neph forfits his responsibility in how the tx. is affecting his patients. If they cramp or crash it is of no significance to him as he is out of sight out of mind. I know that sounds horrible and it is.
Nephs, as well as staff, blame the patients when there are incidents, when problems are not always related to fluid overloading. When the problems are not related to fluid overloading they don’t have the answers. Because, again, it comes back to inadequate education on the dialysis tx of both nephs and staff.
My point is, nephs who take such a mediocre approach to their patients’ care due to their own lack of education on the tx., and inadequately trained staff, both of which also do not stay abreast of current developments within the field, do not give patients quality care. They do not educate patients in intelligent ways as they themselves are not competently educated on the tx. And this makes for a dysfunctional type of care where staff become controlling and baby patients and patients are prevented from becoming empowered in their care.
Personally, I feel nephrologists are like any other human beings- there’s those who give 100% and those who don’t. Are all doctors competent/honest? All car mechanics? All lawyers? No, we know they are not and we shop around. But with dialysis as in other fields, patients don’t always have lots of choices should they not like their neph’s standards and professional behavior.
Nephs know there are better txs. and will tell you that if they were the patient they would be doing home txs. But they don’t go the extra mile to educate their patients, advocate self-care or look into how their patients could get into home programs.
I would be ringing after 11pm because every 2 week my partner changes shifts, and at this time, isnt home until midnight. And I dont go on the machine until he gets home. Most of my problems lately have been water related. And it is so frustrating when you cant go on the machine because of a simple problem. A few weeks ago I had so many problems and missed so much treatment, that I ended up in emergency overloaded and couldnt breathe. By the time I could get dialysis, I could only do 4 hours in centre. And then the nurse that put me on the machine dialed in the wrong fluid amount. So I went home with more fluid on top of the 7 litres I already had.
Our doctors dont know how to operate the machines either, but they at least know enough to know how to give us the prescription for it. I dont know how necessary it would be for them to learn.
All nurses at our unit are registered (as far as I know), I didnt think you could be putting people on the machines if you werent? Im not up with all that info.