Stanford Health Care has launched an innovative digital tool aimed at streamlining the scheduling of dialysis treatments within its inpatient units.
This latest initiative, led by Nursing Informatics and Analytics in partnership with other teams in TDS, seeks to tackle longstanding challenges associated with coordinating care in a high-demand environment.
“One of the problems that the organization and all the inpatient care units face is knowing when the dialysis nurse is going to be able to turn up and do the dialysis treatment,” explained Darren Bates, Patient Care Manager for Dialysis Triaging at Stanford Health Care. “Prioritizing dialysis treatments across the organization is a very complex process.”
The Snapboard, an Epic tool that facilitates efficient workflows for scheduling appointments, assigning resources, and managing schedules, officially went live April 23. “The Snapboard is instrumental in bringing that visibility and communication organization-wide,” said Bates.
With around 50 dialysis nurses and six dialysis technicians facilitating approximately 1,200 treatments each month on the hospital campus, the new tool promises to enhance visibility in real time, allowing nurses and medical teams to better anticipate when dialysis nurses will arrive. This will help to reduce the likelihood of double bookings and improve overall efficiency in patient management when prioritizing urgent treatments alongside routine procedures.
“We’re constantly facing various levels of clinical urgency,” said Bates. “Suddenly we find patients are hyperkalemic [with high potassium levels] and they need immediate dialysis. Suddenly, patients are very, very sick on the intensive care unit and need continuous dialysis starting straight away. Alongside all of the regularly scheduled, thrice-weekly dialysis patients we have, we also have to accommodate these other kind of clinical emergencies.
“We will now have much better visibility on when patient is free and available, and less wasted time setting equipment up at the bedside to find patient has gone somewhere else. That’s going to be really, really helpful for us,” he continued.
Angela Chen, Senior Program Manager, Nursing Informatics & Analytics, noted that this project got its start from discharge planning optimization efforts. A lot of the changes we are making are to create greater transparency into patient progress towards discharge, and now that dialysis is using Snapboard, teams can have insight into patients’ appointments and can better plan for discharge.
“Many patients have to get dialysis before getting discharged, so we started analyzing what our current state was and identifying how we could enhance workflows with tools we have in Epic,” she said. “Dialysis is a fluid department so we needed to customize the tool to meet the department needs.”
The drag-and-drop functionality of the dialysis Snapboard makes it easy to use, Chen said. “You don’t have to navigate through lengthy processes to schedule a patient — it’s designed with clinicians in mind.
“Since the Dialysis Resource Nurse is in constant communication with the bedside dialysis nurses who are scattered across 800P, this visual aid becomes essential. For instance, when the dialysis nurse checks a patient in, the status changes to pink. If they’re currently receiving treatment, it turns green, and when the treatment is complete, it shifts to gray. This color coding allows staff to easily track the status of hemodialysis treatments at a glance,” she said. Nephrologists also have access to the Snapboard, so this allows visibility of the dialysis schedule.
“This was definitely a team effort that crossed various areas of TDS — not only the inpatient team, Adrian Espiritu and Brian Schenone — but we also worked with Cynthia Dalipe from the Cadence team, who are scheduling experts. And Christopher Witek from Informatics.
Education helped to create education that supported our go-live,” she said. Additionally, our team’s Epic Optimization champion, Lex Estioko, assisted with education and go-live support.
Bates added, “From my perspective as dialysis manager, I think the dialysis Snapboard rollout has been excellent. Angela and her team were so responsive and provided plenty of support. That’s what’s made the roll out so successful.”
