Boston—At a large dialysis provider, nurses are assigned to have in-person assessment of patients identified as high risk for poor outcomes. The care coordination unit makes the assignments utilizing assessments made during the patient’s regularly scheduled dialysis treatments; the assessments serve as additional check-in on the patient’s health and well-being. Many hours of work each week are required to identify which patients should be scheduled for the in-person assessment.
Tommy Blanchard, PhD, and colleagues at Fresenius Medical Care North American have developed an algorithm to automate the nurse schedule. They outlined the algorithm during a poster session at the NKF Spring Clinical Meetings in a poster titled Algorithm for Scheduling Nurse Visits for Dialysis Patients.
The algorithm is based on two factors: (1) a patient’s total risk stratification score, determined by a number of risk factors; and (2) number of weeks since the previous visit. The two factors are combined to create a priority score. High-risk patients who have not been seen recently will be given the highest score, and low-risk patients who have been seen recently will receive the lowest score.
Nurses can visit more than one clinic in a day. The calculation of travel time between clinics is accomplished using Google Maps application programming interface (assuming 1 hour for each patient visit).
Results of implementing the algorithm were: (1) find a clinic and treatment shift that would allow a nurse to see patients with the highest priority score; (2) find the clinic that would give the highest cumulative priority score for the patients that could be seen within the allotted travel time; (3) seek small improvements by repeating step 2, assuming fewer patients are seen at clinic 1 would free up more time to see patients at clinic 2. Assess the day’s trip to ascertain whether any of the solutions improved the total patient priority scores. Repeat steps one to three as required for a given week.
“Automating scheduling nurses may improve the efficiency of resources, can give priority to patients that need more visits, reduces time for scheduling, and allows for high priority patients to be seen sooner, avoiding unnecessary hospitalizations,” the researchers said.
Source: Blanchard T, Usvyat L, Demaline J, Aronson A, Conti J, Maddux F. Algorithm for scheduling nurse visits for dialysis patients. Abstract of a poster presented at the National Kidney Foundation 2019 Spring Clinical Meetings, May 8-12, 2019, Boston, Massachusetts.