Focus on rehabilitation: teamwork that works.

The end-stage renal disease patient has progressed in the past 25 years from the patient who was chosen by a committee to continue life, to a patient who chooses to live well on dialysis. The Vanderbilt Dialysis Clinic (VDC) has developed a collaborative team approach to enable the patient to more effectively achieve this goal. The emphasis has been placed on the patient's "ability, not disability." The collaborative effort of the staff at the VDC has evolved based on the perspective of a team concept. Each discipline or member of the team has a specific goal but functions in a manner that is interdependent of the other team members. The physician, nurses, dietitians, social workers, technicians, and activities director all play an important role in the concept of rehabilitating the whole person. The key to a successful rehabilitation program is to begin with interested patients and staff to serve as a catalyst for others. The Rehabilitation Program at VDC has been based on the principles of continuous quality improvement (CQI) at the unit. The team used the CQI process to brainstorm ideas to implement the exercise program, to overcome barriers to success, and to recognize opportunities to motivate patients and staff. Physicians, nurses, technicians, and dietitians worked together to develop the screening protocols so that the staff would feel comfortable when assessing the patient for exercise. An exercise physiologist from Vanderbilt's Kim Dayani Human Performance Center participated in evaluating the exercise screening information and worked with individual patients and staff members as the program began. Equipment was acquired in the form of used stationary bicycles, smaller ergometer-style pedals, hand and ankle weights, and therabands. The exercise program was initiated with only 2 to 4 patients per week participating, after which time it was evaluated and modified. VDC discovered that heightened awareness does indeed impact the level of participation in the facility. The Rehabilitation Team implemented the exercise program in October 1996 with 60% patient participation, yet within 6 months, participation decreased to 25%. One year later in conjunction with a Rehabilitation Fair, interest again peaked to a participation level of 60% in the center and 66% with the home dialysis population. While the improvement in participation may have been due to more quantifiable measurement, it is perhaps more reflective of the emphasis placed on the importance of exercise. Motivators such as an Annual Rehabilitation Fair in which all areas of the Life Options Rehabilitation Advisory Council's "5 E's"--encouragement, education, exercise, employment, and evaluation--are emphasized and have been effective in generating renewed interest among staff and patients in improving overall rehabilitation of patients at the VDC. Continuous motivation of patients and staff through ongoing program implementation, evaluation, and modification based on the CQI process is necessary to maintain everyone's level of interest.

Renal rehabilitation: keys to success. Case study of the anemic patient.

Rehabilitation of dialysis patients was an original goal of the Medicare End-stage Renal Disease (ESRD) program. Since this program's inception, advances in technology (e.g., better dialysis equipment) and pharmacology (e.g., maintenance of an optimum hematocrit with Epoetin alfa) have greatly improved the care of patients with ESRD and increased the potential for successful rehabilitation. Recognizing the importance of rehabilitation, many health providers and patients have focused attention on developing innovative programs that can help improve outcomes. A key component of successful programs is the formation of a multidisciplinary team that actively plans, directs, and participates in the rehabilitation effort. This article provides case study overviews from three dialysis centers, including key steps that can ensure a continual focus on rehabilitation.