ABSTRACT
Background: In US, only 12% of ESRD patients utilize PD as his/her RRT modality. Part of the reason is lack of effective education tool. Kaiser Permanente Northern California is an integrated health care system providing health care to 4.6 million members in greater San Francisco Bay area. We piloted a proof-of-concept study to test if utilizing virtual reality can improve patient dialysis modality education. Method(s): Nephrologists, PD nurses and technology-centered team from KPNC met regularly in 2019 to find out the gaps in dialysis modality educations. After several meetings and reviewing the current educational material, we decided to produce a 360 immersive video with 3 separate segments using a GoPro Camera. Google cardboard is used as the VR tool. We then tested on 9 patients during their patient education section. Result(s): Three segments showing nursing home visit, patient performing PD at home and patient sleeping during PD were produced. They can be assessed on YouTube: https:// www.youtube.com/watch?v=BayBNoZbNbA. We tested this VR tool for 9 patients. This number was limited due to in person trainings being curtailed during the COVID-19 pandemic. Most patients felt that the first-person nature of the video (without VR) helped because the content was so helpful. However, there were some challenges: some patient became confused due to too much movement needed, not able to focus. Overall, patients appreciated the content but felt the 360 VR was not needed. They hoped if the video could be steadied, they would have a better experience. Table one listed the demographics and feedbacks. Conclusion(s): VR is a viable option for better patient education if it can be improved with better ease of use. Further studies with improved technology and larger numbers of patients are warranted to improve patient dialysis modality education. (Table Presented).
ABSTRACT
Background: ESRD patients with tracheostomy require long-term mechanical ventilation in addition to need for maintenance dialysis. Due to regulations in California, majority of such patients have prolonged acute hospital stays due to lack of availability of a lower level of care facility, capable of providing ventilation care and hemodialysis. Need for these services increased during the COVID 19 pandemic. Kaiser Permanente Northern California (KPNC) is an integrated health care system providing health care for 4.6 million members. Partnering with a large dialysis organization (LDO) and a local Subacute Care facility (SAC), a program has been developed to provide home hemodialysis for patients requiring long-term mechanical ventilation using Low Dialysate Volume Approach (LDVA) machines. Method(s): The program was initiated in Q4 2017. A set of clinical criteria for admission was developed between the LDO, SAC and KPNC. Weekly meetings with physicians, dialysis nurses, and SAC staffs were conducted to review the potential candidates currently hospitalized in one of twenty-one KPNC hospitals. Dialysis has been performed by a HD nurse four times a week (M-T-Th-F) for 3-3.5 hours for each dialysis treatment. Each treatment was conducted using a LDVA machine with standard LDVA prescriptions using a Watson calculator to achieve a weekly Kt/V above 2.1. Result(s): Since the inception of the program, 45 patients have been admitted to the program, 24 female and 21 male patients. The mean age is 65 (+/-13) on the date of admission. The average length of stay per patient at an acute hospital prior to admission was 125 days, and after the admission, the total days in the SAC is 7,498 days, an average of 167 days per person. Total acute hospital re-admission days after admission to the program is 1,071 days, an average of 25 days per patient (range: 0 to 115 days). Nine patients are currently residing in the SAC. Conclusion(s): It is feasible to provide hemodialysis care for patients requiring long term mechanical ventilation at the appropriate level of care. This approach reduces the patient length of stay (LOS) in acute hospitals and burden to critically stretched healthcare system. Further discussion with local regulatory agencies is needed to develop additional models of care to effectively deliver dialysis to patients requiring facility-based long-term care.