There are five main administrative barriers that Ann Robar, BSN, RN, CNN, from Satellite discussed during the conference. Those barriers were: infrastructure, efficiency, autonomy, community awareness and physician support.
"A typical home program was stuck in a closet at the end of a hall with one to two rooms and a part-time nurse," Robar said. “The result was that when patients and physicians needed a home nurse, often times they were not available. We changed that model and had dedicated nurses for home therapies specifically.”
More nurses were trained to home therapy as a specialty. Satellite looked at those nurses at the end of the hall in the closet and noticed that they weren’t getting the same attention as the in-center staff was, Robar said. The lack of administrator and technical support was present.
In order to have fiscal efficiency a clinic has to have high volume, according to Robar. In order to gain higher volume and efficiency. Satellite started regional centers where training would be held and problems would be dealt with.
“As a result, it enhanced the skills for our clinicians because as they saw more problems they became more comfortable dealing with those problems and recognizing them,” Robar said.
Adequate space was very important for the training sessions to take place. The previous rooms were not good enough to train someone how to dialyze. Aesthetics also became important because the staff didn't want the patient to feel like they were in a clinical setting.
One key element driving patient volume is education, Robar said. If a patient receives education prior to making a decision weather to stay in-center or choose home therapies, the patient is more likely to choose home therapies.
Protocols were established for HHD as well as PD. Those protocols were implemented into all of the Satellite programs.
Community awareness became a big focus because the only way to grow a program is if people find out and learn about it, she adde“We go out into the community. We visit senior centers, community centers, health fairs. We speak about kidney disease and encourage people to go see a nephrologist,” she said.
In addition to getting the word out to patients, the staff was educated, not only the home hemo staff, but also the in-center staff in case a patients curiosity kicked in. Others, outside the center, involved with patient care had to be included as well.