Background: In 2017, Emory University Hospital Midtown (EUHM) instituted fast track dialysis (FTD) which identified low risk patients in the emergency department (ED) in need of hemodialysis (HD) and provided it efficiently. The FTD development team consisted of hospital medicine, emergency medicine, nephrology, dialysis unit nursing, and ED nursing. This program showed a reduction in hospital length of stay from 27 hours to 12.8 hours and a reduction in charges associated from the visit from $30,600 to $26,040.

Methods: In year 2 (FTD2), we transitioned FTD at EUHM from being run by hospital medicine to being based run by emergency medicine in the clinical decision unit (CDU). Meanwhile, we introduced the FTD pathway to the ED at Emory University Hospital (EUH). For data analysis, we compared a 1-year interval from December 2018 to November 2019 to baseline data from year 1 of FTD.

Results: At EUHM, there were 143 patients in our historical control group and 216 patients in our FTD2 intervention cohort. At this site, we found that there was no significant change in the median LOS during daytime hours (12.8 hours vs 12.92 hours) but significantly reduced median charges ($26,040 vs $7,127) and median discharge to door time (2.44 hours vs 0.62 hours).At EUH, there were 66 patients in the historical control group and 174 patients in the FTD2 intervention cohort. The FTD pathway reduced LOS in the intervention cohort from 10.63 hours to 9.88 hours, but the LOS data includes approximately a dozen encounters with limited LOS information. Median charges increased from $4,460 to $5,459 and median door to discharge time significantly reduced from 0.42 hours to 0.14 hours.

Conclusions: At both sites, there was increased use of the FTD pathway for FTD2. Initiating the pathway seems to reduce LOS but the venue (CDU vs hospital unit) does not affect LOS. Utilizing the pathway in the CDU leads to efficient discharging and significantly reduced hospital charges compared to observing the patients on the hospital floors.

IMAGE 1: Charges and length of stay during year 2 of fast track dialysis at two hospitals