Bringing Innovative Dialysis Care to a Long-Term Acute Care (LTAC) Hospital in Rural Northern California
Summary
Vibra Hospital of Northern California is addressing the need for hemodialysis care in the region and is growing its LTAC program after a successful conversion from outsourced to insourced care.
Vibra Hospital of Northern California in Redding is the only long-term acute care (LTAC) hospital in the rural region of the West Coast stretching from north of Sacramento to south of Portland, OR. Care for dialysis patients at this specialty facility is particularly problematic, with only three nephrologists serving the entire area, a growing end-stage renal disease (ESRD) population and patients and their families often having to drive far distances for outpatient intermittent hemodialysis (IHD).
Recently, Vibra Healthcare’s corporate leadership decided to bring in-house IHD services, featuring Outset Medical’s first-of-its-kind Tablo® Hemodialysis System, to several of its hospitals including Vibra Hospital of Northern California. Vibra Hospital of Northern California started managing its own Tablo program in December of 2022.
Why and how did this medical rehabilitation and critical care hospital system make such a significant decision to bring this critical patient care service in-house?
It comes down to doing what’s best for patients, and the collaborative partnership with the Outset Medical team helped create a positive, staff-empowering experience, says Emily DeFillipo, PT, DPT, Chief Executive Officer of Vibra Hospital of Northern California, and Darla Perdue, MSN, RN, Chief Clinical Officer of Vibra Healthcare.
Since going live with Tablo, the hospital’s dialysis team has been able to address the need in its rural region for IHD patient care and expand its dialysis program. The team also has a stellar Department of Public Health inspection report to show for it.
A Predicament: Inadequate Outsourced Service
DeFillipo explains that in mid-2022, Vibra Hospital of Northern California was faced with limited service and a significant increase in price for its dialysis contract services.
“We were unable to provide dialysis service for our critical patients,” she says. “We were actually having to limit the number of patients we could serve, which would create a large ripple effect with all of the local STAC [short-term acute care] hospitals. Our nephrologists were not okay with this either. Our team at the corporate office was seeing similar trends across the country and started looking at opportunities for us to service our communities to the fullest potential,” DeFillipo continues.
“Unfortunately, we could only manage so many patients,” adds Perdue. “We couldn’t continue operating this way, it wasn’t the best thing for the patients. We knew it was time to create and control our own program because we knew we could do a great job.”
Perdue, with more than 26 years of progressive and critical care clinical experience and 17 years in senior-level executive leadership, first heard of Tablo in 2016. Although the Vibra Healthcare system was using another dialysis technology at the time, she kept an eye on Outset Medical and its Tablo device. Six years later, she and other health system leadership met with the Outset team and assessed the financial and operational impact of insourced versus third-party dialysis care. Then, Perdue and the corporate team proposed to DeFillipo and Sheba Saelee, RN, DNP, who serves as Chief Clinical Officer, Chief Nursing Officer and Chief Operating Officer at Vibra Hospital of Northern California, about bringing dialysis in-house at their facility.
Vibra Healthcare and the Outset team formulated a plan to launch in-house dialysis programs with Tablo across 10 Vibra Healthcare critical care and medical rehabilitation hospitals over a two-year timespan. Four have been launched to date, with Vibra Hospital of Northern California coming online with a fleet of Tablo consoles on December 1, 2022.
Perdue says the close collaboration with Outset has been hugely instrumental to their success. “The partnership with Outset is phenomenal because they have the education team and the clinical expertise to partner with us and train our own staff,” says Perdue.
Nursing and Nephrologist Concerns Alleviated
DeFillipo and Saelee were concerned at first about finding in-house dialysis staff for their new program. Another challenge to overcome: the nephrologists were against bringing dialysis in-house. Innovation was the answer to both issues.
At that point, Lauren Lindsey, RN, ADN, now a Certified Dialysis Nurse and Dialysis Nurse Manager, came in to interview. She was hired to help lead the new in-house program, and DeFillipo says she was able to quickly train and become competent in performing IHD treatments with Tablo, even without a previous dialysis background. Other dialysis team members were hired and trained as well.
“I had always been interested in dialysis in my healthcare career and during nursing school. I was excited to be part of starting an in-house program from the ground up,” says Lindsey.
“I think it needs to be spotlighted for other programs considering Tablo that you don’t have to have a dialysis nurse with 20 years of experience to perform good dialysis.” – Emily DeFillipo, PT, DPT
“Lauren was agreeable to step up and take on this position, and do the training,” says DeFillipo. “The Outset team was there to partner and work with her on a consistent basis. At first, we thought it was going to be a huge limiting factor, but with the ease of use of Tablo they trained a nurse with no dialysis experience to be able to perform dialysis at a very high level.
If you have nurses with an interest in improving their skills and growing within their profession, they can be trained in a short amount of time on Tablo. Big kudos to Lauren and Sheba for taking on an endeavor we had no experience in and taking it to where we are today.”
“Outset was a key part of our success,” adds Lindsey. “Our rep was amazing, he sat us down and did a four-hour in-service training on everything about the machine, and he did mock treatments with us. We could also text or call him anytime we needed. The Tablo training on Outset University is also very helpful, and it’s now part of our nurses’ online orientation.”
As part of the new program launch, Sriram Sambasivan, MD, one of their three local nephrologists, agreed to take on the position of Nephrology Medical Director at the Redding facility. DeFillipo says Dr. Sambasivan and the two other nephrologists expressed concern at first that very experienced dialysis nurses would be needed to start up and run an in-house program. Their perspective was based on years of traditionally complex processes in dialysis machine operation and ancillary support. DeFillipo and others on the Vibra Healthcare team, along with the Outset team, worked with the physicians to show them that is no longer the case, and trained them on the innovation built into Tablo.
“Once Dr. Sambasivan understood how the machine worked to provide adequate dialysis for patients and how easy it is to use, his support was a turning point for our whole group that we were headed in the right direction with this launch,” says DeFillipo. “Outset really stepped up and was there to help support us to turn the physicians’ perspective around that we could do this. Our most pessimistic physician who thought we shouldn’t and couldn’t do this, is now coming to me saying ‘why aren’t you taking more patients’?”
An Impressive State Inspection
As the new program at Vibra Hospital of Northern California has progressed over the past several months, the team has been able to accept more patients. And proof of its success was recently confirmed in a state inspection.
In April 2023, a representative of the California Department of Public Health (CDPH), the government body that oversees licensing and recertification of health facilities, arrived for an unannounced inspection of Vibra Hospital of Northern California. This was a chance for the team to shine.
“It was actually a previous dialysis nurse who came in from CDPH, and she was extremely happy with everything Sheba and Lauren had been doing across the board,” says DeFillipo. “She inspected our program and our practices, and found it’s not only efficient but above and beyond what was required.”
“The inspector said our practices, documentation and outcomes were phenomenal, and it was all based on utilizing the [Tablo] device and being able to pull the outcomes reports and other information we can obtain through the cloud,” adds Perdue. “Also because of the education that was provided to us, the partnership we have with Outset, and even the troubleshooting and quality metrics calls we have with the Outset team. The State was incredibly impressed. It’s humbling because the Department of Health came in and said we are doing a phenomenal job. That’s our mission and our vision is providing excellent care to our patients and having excellent outcomes, that’s what we do.”
“I think Lauren was in the middle of a dialysis session at the time of the inspection,” adds Saelee. “The inspector had mentioned her background was in dialysis nursing and she had learned about Tablo at a nursing conference about five years ago. She knew what this machine was designed to do, but finally seeing it in action for the first time in the middle of nowhere in Northern California was just fantastic. She wanted to see a treatment, and the handling of materials in and out of storage. She was so happy to see the wonderful things it was doing, and she gave us a letter saying we had no deficiencies. We will always be doing what we do best, and that’s safe practices.”
A Program that Inspires Other Nurses
Saelee says the most significant impact since their program launch has been the ability to extend dialysis service in-house, and the interest from nurses outside of dialysis. “It’s something we’re super proud of,” she says. “Nurses are now asking, ‘how do I get on this dialysis team?’ We also haven’t had to reschedule a dialysis session because the contracted service wasn’t able to provide us with a nurse. There are just so many significant impacts as far as serving our very unique patient population in this isolated area, and not having to rely on a third party to do that for us.”
About Vibra Hospital of Northern California
Vibra Hospital of Northern California is a critical care hospital provider located in Redding, California. The hospital is part of Vibra Healthcare’s nationwide network of specialty hospitals. Designed for patients requiring extended periods of hospitalization, the hospital treats individuals suffering from a range of complex conditions, including respiratory, cardiac, neurological, infectious disease, multi-system, and wound healing issues. To learn more about Vibra Hospital of Northern California, please visit www.norcalrehab.com.
Image at top of the page: Exterior view of Vibra Hospital of Northern California, Redding, CA.
* Indication statement:
The Tablo® Hemodialysis System is indicated for use in patients with acute and/or chronic renal failure, with or without ultrafiltration, in an acute or chronic care facility. Treatments must be administered under physician’s prescription and observed by a trained individual who is considered competent in the use of the device. The Tablo Hemodialysis System is also indicated for use in the home. Treatment types available include Intermittent Hemodialysis (IHD), Sustained Low Efficiency Dialysis (SLED/ SLEDD), Prolonged Intermittent Renal Replacement Therapy (PIRRT), and Isolated Ultrafiltration.
* Caution statement:
This device is not indicated for continuous renal replacement therapy (CRRT) and is cleared for use for up to 24 hours. The dialysate generated by this device is not sterile and should not be used for intravenous (IV) infusion.
* Disclaimers:
For safety and effectiveness information, indications for use, risks, cautions and warnings, please refer to the product labeling for the Tablo Hemodialysis System.
The views and opinions expressed in this blog post represent the personal opinions of the parties interviewed. The content should not be taken as medical advice. Never ignore professional medical advice in seeking treatment because of content you have read on the Outset Medical website.