Great post, finally got the time to read. There’s probably an interesting story in who’s in the KW exhibit hall over the years, would be a good proxy for where the field has been and is going.
I’d love to hear more about the big, unanswered questions standing between end users and innovations. What are the gaps?
Your ending was spot on. We’re at the point where system changes are imperative to support innovation. You can’t build it and hope systemic change will follow.
Hi Tim. Regarding moving patients to home hemodialysis the question was what is the obstacle(s). Is it the device or something else. In my experience this is a very convoluted question and we need to look back to before the patient had to start RRT.
What kind of care did the patient receive before dialysis? Were they a crasher into dialysis or did they see a nephrologist? If they saw a nephrologist, was there discussion around all the modality options for the patient to make an informed consent? Is the nephrologist comfortable discussing home hemodialysis and does he/she understand how to order a prescription for home hemodialysis? Did the patient get the opportunity to experience more frequent dialysis in a transitional unit when starting dialysis. If they were a crasher, did they immediately go to ICHD or did they begin in a transitional care unit/
There is alway so much focus on the device. This is a big component but patients are smart and resilient and good home training nurses can teach any device to patients. If you remember patients used to go home with "traditional" dialysis machines and portable ROs. Todays devices are not as intimidating as traditional equipment when compared.
Are the training nurses good at "training" and educating patients versus case management. We want the best training nurses completing the patient training versus nurses that are not as good. We want success for the patient during training but also continued success after training.
But what about all the other "stuff" once the machine is mastered? We must be honest with the patient that is choosing home hemodiaysis. It is work! We cannot say " it is easy once you learn the machine". Yes it will be challenging but it will get better the more the patient performs their dialysis and time goes on.
Is the patient comfortable with cannulation? Does the patient understand and know when to call the home nurse for any issues and do they know what issues they should call for? Do they actually call the home nurse when needed or put the call off for fear of having to go to the hospital? What about supplies, lab supplies, drawing blood, giving medications/dosing medications, etc. There are so many components beyond the "device" that sometime all the other "stuff" gets lost.
Another component is caregiver or patient burn out in home hemodialysis. Is the patient getting overwhelmed and do they need a break for a short time? Is the patient overwhelming their caregiver by giving all the duties/responsbilities to them? Caregivers want to care for and help their loved ones, but do they speak up? Respite care should be offered to home hemodialysis patients and their caregivers so there is a break from time to time. This must to be assessed by the healthcare team each month.
![Signals From [Space]](https://substackcdn.com/image/fetch/e_trim:10:white/e_trim:10:transparent/h_72,c_limit,f_auto,q_auto:good,fl_progressive:steep/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2F2efc1ef1-ba0b-4ca3-b9f6-a9a790da4b38_1344x256.png)
![Signals From [Space]](https://substackcdn.com/image/fetch/w_36,h_36,c_fill,f_webp,q_auto:good,fl_progressive:steep,g_auto/https%3A%2F%2Fsubstack-post-media.s3.amazonaws.com%2Fpublic%2Fimages%2Fa4736f49-6a20-4fd6-a3de-d48cb4b105f2_375x375.png)
Great post, finally got the time to read. There’s probably an interesting story in who’s in the KW exhibit hall over the years, would be a good proxy for where the field has been and is going.
I’d love to hear more about the big, unanswered questions standing between end users and innovations. What are the gaps?
Your ending was spot on. We’re at the point where system changes are imperative to support innovation. You can’t build it and hope systemic change will follow.
Hi Tim. Regarding moving patients to home hemodialysis the question was what is the obstacle(s). Is it the device or something else. In my experience this is a very convoluted question and we need to look back to before the patient had to start RRT.
What kind of care did the patient receive before dialysis? Were they a crasher into dialysis or did they see a nephrologist? If they saw a nephrologist, was there discussion around all the modality options for the patient to make an informed consent? Is the nephrologist comfortable discussing home hemodialysis and does he/she understand how to order a prescription for home hemodialysis? Did the patient get the opportunity to experience more frequent dialysis in a transitional unit when starting dialysis. If they were a crasher, did they immediately go to ICHD or did they begin in a transitional care unit/
There is alway so much focus on the device. This is a big component but patients are smart and resilient and good home training nurses can teach any device to patients. If you remember patients used to go home with "traditional" dialysis machines and portable ROs. Todays devices are not as intimidating as traditional equipment when compared.
Are the training nurses good at "training" and educating patients versus case management. We want the best training nurses completing the patient training versus nurses that are not as good. We want success for the patient during training but also continued success after training.
But what about all the other "stuff" once the machine is mastered? We must be honest with the patient that is choosing home hemodiaysis. It is work! We cannot say " it is easy once you learn the machine". Yes it will be challenging but it will get better the more the patient performs their dialysis and time goes on.
Is the patient comfortable with cannulation? Does the patient understand and know when to call the home nurse for any issues and do they know what issues they should call for? Do they actually call the home nurse when needed or put the call off for fear of having to go to the hospital? What about supplies, lab supplies, drawing blood, giving medications/dosing medications, etc. There are so many components beyond the "device" that sometime all the other "stuff" gets lost.
Another component is caregiver or patient burn out in home hemodialysis. Is the patient getting overwhelmed and do they need a break for a short time? Is the patient overwhelming their caregiver by giving all the duties/responsbilities to them? Caregivers want to care for and help their loved ones, but do they speak up? Respite care should be offered to home hemodialysis patients and their caregivers so there is a break from time to time. This must to be assessed by the healthcare team each month.