Initiative to improve the quality of patient care for chronic dialysis patients in the inpatient setting

To the Editor Proper inter and intrahospital transfers remain a crucial part of the safe delivery of medical care. The most critical but often missed part of the transfer is documentation. The University of Florida (UF), Shands hospital is a large academic medical center with over 1000 beds and over 300 ICU beds that care for many patients with kidney failure on hemodialysis. We recognized that the chronic hemodialysis treatment plan was not documented in adult patients’ charts when admitted to the inpatient facility (medical wards and ICU). Chronic hemodialysis treatments were provided at various outpatient facilities (privately owned or hospital-based). The dialysis center nephrologists managed the outpatient dialysis unit, and the on-call nephrologists managed inpatient treatments. We observed that patients without appropriate documentation received different hemodialysis treatments or medication dosages (erythropoietin, vitamin D analogs, antibiotics, etc.) during hospitalization. To mitigate the situation and improve the quality of medical care and patient safety, we implemented a quality improvement (QI) project to identify the cause(s) of the inaccessibility of medical records and enact a plan to rectify the situation. The SMART aim (specific, measurable, achievable, realistic, time-bound) of this QI project is to increase the availability of complete outside medical records to consulting nephrologists by >95% in 9 months. Our QI project focuses on increasing value with zero harm.