Abstract
Background and Aims
Dialysis units face an increasing shortage in qualified healthcare professionals (HCPs). Multiple studies1,2 have suggested that staffing shortages and the clinic work environment affect both patient and organizational outcomes, resulting in higher workloads and more stressful work environments. This may lead to staff disengagement, burnout, absenteeism, voluntary turnover, reduced patient satisfaction and potentially adverse patient outcomes.
Nurses have a significant role in the delivery of haemodialysis (HD) therapy for end-stage renal disease patients. While supporting patients in navigating their everyday lives, including HD therapy, nurses balance a variety of challenges related to care and coordination. This study analyses how four main categories of dialysis technologies (HD machines, digital technologies, water treatment systems, and other medical devices) can reduce the complexity in daily haemodialysis process steps, relieving nurse workload and thus freeing up more time for patient care.
Method
This observational study was conducted in three phases. First, we analysed the process steps in a typical working day in a haemodialysis care facility, mapping them to the best practice standards3. In a second phase, we analysed the data via a Delphi panel of 19 experts (international multidisciplinary team). The initial mapping was discussed in 10 moderated rounds (2 moderators) to quantify the process step improvements resulting from four main categories of modern HD technologies: HD machines (HDM), digital technologies (DT), water treatment systems (WT), other medical devices including motorized chairs/beds & digital weighing scales (Miscellaneous). In phase 3 an assessment was performed to determine how modern HD technologies and the combination of the four main categories (Setup B) could potentially improve daily process steps versus a conventional dialysis clinic set-up (Setup A).
Results
A total of 146 daily process steps were identified over the course of a single HD session. Table 1 shows, how the four main categories of dialysis technologies individually contribute to improving the number of process steps, when applying modern technologies (Setup B) versus a conventional setup (Setup A). Additional process step improvements were identified that result from the specific combinations of the four technology categories. The maximum improvement that can be achieved through a combination of all 4 categories is 95 out of 146 process steps. Overall, the biggest contributors to process step improvements were HD machines (39 steps improved) followed by digital technologies (25 steps improved). In terms of technology combinations Digital Technologies and Water Treatment Systems lead to the highest number of process step improvements. In Setup A, a total of only 10 out of 146 process steps were improved, while in Setup B 95 out of 146 process steps were improved. Hence, the net improvement achieved with Setup B vs. Setup A was 85 process steps. This equates to a 58% improvement of total number of process steps.
Conclusion
Our results indicate that a 58% net improvement in daily process steps could be achieved versus a conventional setup. These findings suggest that investments in modern technologies may reduce the complexity in dialysis clinics, easing stress levels, improving the overall working environment, and freeing up more time for patient care. Changes in the work environment in renal care facilities have been observed to have several beneficial effects: a higher job satisfaction, lower stress and burnout levels, reduced intention to leave and higher staff retention can be achieved1,2. Further studies are required to validate the findings of this analysis.
1) Applebaum D et al. J Nurs Adm (2010); 40: 323-328.
2) Hayes B et al. J Nurs Manag (2015); 23: 588-98.
3) EDTNA/ERCA Nurses Best Practice Guidelines. https://www.edtnaerca.org/education/publications. Accessed: 10th Jan 2021
Defining changes in the educational environment in the context of the introduction of information and computer technologies
