Here come the questions....

[jdbnomad]

OK...I was told I could not just sit back and listen....so I might as well get to the point and ask about things that are on my mind.

If you didnt see my "Intoduce myself" post...I am a person that works at the corporate level of one of the major providers.  20 years re-use, patient care, technical, management, water system installer, now consultant.

Life on both sides of the needle is about doing things for the right reason.

So my first questions I would like to ask....

In a clinic, what are the most important comforts that make can make 4 hours seem like 2 hours?

In the past it has been 1- Temperature 2- Chair comfort 3- Good TV's
I know it can't be just that simple....I would love it if you could expound on that and share your stories.


I am also just curious...

Has anyone ever showed you the inside of the dialysis machine and explained its function?  (Its technical but not rocket science)  And have you seen the water room in your clinic?  Do you know, or would you like to know about how that process works?


Go ahead and flame me if I am asking n00b questions.  I have broad shoulders and a flame retardant jump suit. 


JDBnomad

[Meinuk]

We actually save our flaming for the political threads....


Here are some posts that may answer some of your future questions:

http://ihatedialysis.com/forum/index.php?topic=5273.msg76377#msg76377

As far as technical demonstrations, I believe that we are all self taught here.  (except Hawkeye, he is a pro)

Bill Peckham has started photo archive over at his blog with some "behind the scenes photos" http://www.billpeckham.com/photos/dialysis_photo_archive/

My observation is that units have a hard enough time providing dialysis.  The tours generally consist of "here is the bathroom, here is the Nurses station, now sit in your chair and watch TV."

Any effort to educate people in CKD-5 is greatly appreciated.  I a lot of cases, removing the mystery mitigates some fear.

Welcome to IHD.

[flip]

I'm more concerned about events like Jacksonville, Illinois and Lufkin, Texas. What are companies doing at a corporate level to insure that tradegedies like these don't happen again ?

[Meinuk]

Flip, add Hialeah, Florida to that list

http://ihatedialysis.com/forum/index.php?topic=8289.0

Family blames water at clinic for father's critical condition

Related Links
Video: Poisoned water
HIALEAH, Fla. (WSVN) -- A family is angry at a South Florida clinic, blaming the water for their father's critical condition.

According to family members of Tony Estevez, Fresenious Medical Care of Hialeah withheld vital information from the family that is slowly killing their father.

According to his daughter, Noemy Estevez, she can hardly comprehend how they got to this point, after only three weeks ago, her father was exercising with her. Estevez is now recovering from a pentuple bypass. The facility provides dialysis for patients.

Noemy said she continued asked Tony's medical care in Hialeah, if something was wrong. "We continually contacted the center, and I feel that we were continually told nothing out of the ordinary is going on at the center," said the daughter.

Only after Tony had a heart attack did the center admitted there was a problem. Fresenious Medical care of Hialeah told Seven News on Wednesday: "Abnormal conditions in the facility's water system resulting in the presence of chloramine were identified... The abnormal conditions were corrected within 24 hours..."

Noemy Estevez claimed this was all new information, because she always asked the center if there was something wrong. "I just feel that statement in particular does not address us, because at no point were we notified. Contrary to that we notified them," she said

Last month, Tony's family saw a week long of spiral weakness and not eating. "While chloramine or chlorine is added to city water to protect the rest of us from bacteria, it kills red blood cells in patients that are on dialysis," said Robert Boyers the Family's Attorney. "The cover-up is criminal, because in this case the cover-up caused the harm," he added.

Fresenious most recent government inspection last year, came up clean. But in the inspection prior, State Health Regulator cited the clinic twice because water was not adequately purified, the medical director did not have staff privileges at Palmetto General, and patients were dissatisfied with doctor's visits and the amount of contact with their doctor.

The inspector even stated, "This is an accident waiting to happen," said Renee Fletcher.

Estevez remains in critical condition at the clinic.

[stauffenberg]

Some nephrologists insist that the ambient temperature at dialysis centers be set deliberately low, since that helps maintain patients' blood pressure and prevent 'crashing' even if a large amount of fluid has to be withdrawn.

[jdbnomad]

Ok...wow...several topics.  I think I'm gunna be chatting with you all for a while...so...let me start by stating a couple things. 

I am just a person who has seen the good/bad/ugly after 20 years.  I am going to talk about things from a personal level and not as some representitive of a provider or as a corporate schmuck =P

As Meinuk said "In a lot of cases, removing the mystery mitigates some fear."   I think THAT hits it right on the head and maybe thats the best way I can participate.

Topic 1:  Comforts in the centers.

The way it is:   Companies build and fill the clinics on tight budgets and time lines.  In the past, when plotting all the concerns on a chart (regulatory, financial, projected cost/profit analysis, operational), the needs and comforts of the patients hils a small slice of the pie chart.  I have seen this change slightly over the last ...ohh ..maybe 8 years because we realize that, for the most part, its just like any other buisness and compitition drives the market.  Even though 90 some percent of patients are not private pay insurance they are STILL our customers.  And even though the patients dont always have too many choices in dialysis clinics, especially in smaller towns and rural areas, in the bigger markets they do...and they WILL shop around.  Word of mouth is the primary means of this.  Because of this we have seen a shift in how we want to build and fill our clinics.  Some things that I, personaly, like to do are ....indirect lighting so the patients dont have to stare into bulbs when laying back ... making sure that CAT5/6 cables are all run during construction so that if/when they decide to have internet at the stations it won't be such a financial hit .... good window tinting and/or shades ... making sure the HVAC vents are not directly over the patient stations ... requesting heppa (sp?) filters in the HVAC system to cut down on airborne dust particles and maybe help with infection control ... and I have sat in several different brands of chairs for 3-4 hours (which really sucks in some) and have a favorite brand (not going to plug) so thats what I buy...I think I am going to move away from arm mounted TV's and go with ceiling mounted flat panels because they have come down so much in price.  These are all examples of things I can do without costing my company an extreme amount of money on start up costs.  Its a slow process to change.  (On the subject of heated chairs... I am not sold on them yet...its not becuse I want you all to be cold..lol...its because it is a shock hazard.  Every chair has to be electrical safety tested twice a year to maintain compliance with OSHA standards.  and it just makes me nervous having that many more pieces of equipment out there that draw so much current around all the wet processes...especially dialysate acid which is HIGHLY conductive.)

The way it should be:  Everything, within reason, should be done to accomidate the patients AND staff.  Besides the above mentioned items I would LOVE to hear what you would do different in your clinic if you were to build one.  I think WiFi is the next big push.  More and more patients are computer savy and our industry hasn't kept up with pace in my humble opinion.

Topic 2: Water systems

I am going to put this on another post or maybe as another reply....I love teaching this stuff....we techs are not as smart as we would like you all to think....HAHAHA. 

This will cover....

Pretreatment components and function
Reverse Osmosis machines
Distribution loops and systems
Water testing and monitoring
Regulatory


PS:  Please excuse my many typo's and free text typing...I am doing this in my spare time and there's not much of it....typing fast =P

More to come if you all want.

JDBnomad

[paris]

One of the main reasons a lot of us are here is because we want to have power in our care. The more we learn, the more powerful we become.  I think you will be amazed how educated and informed so many are and we always look for more to learn.   There are so many who just walk through life,  never questioning their care.  Hopefully, people like you can help those who don't have the information or the ability to know kidney disease inside out.   Glad to see your questions and look forward to more posts. 

[stauffenberg]

The elephant in the living room in this discussion is the well-established fact that the US has almost twice the death rate among dialysis patients as other industrialized countries do, and the US is the only industrialized country that allows private corporations to provide dialysis on a for-profit basis.  The fact that the very few US non-profit dialysis centers have about the same death rate as that found in other industrialized countries with socialized medicine strongly points to the 'profit-over-people' ideology of the for-profit of American centers as the cause of the higher death rate.

US dialysis profiteers re-use parts of the dialysis machines they shouldn't; they confine patients to shorter, one-size-fits-all treatment times to maximize utilization of capacity; they push patients out of the treatment stations when they're still bleeding in order to get the next shift of profit-makers into the chairs; and generally, they cut every corner of the Medicare dialysis guidelines to squeeze every last penny of profit out of the fixed sum of the Medicare reimbursement.  Even worse, the insanely right-wing US government is complicitous in this lethal mistreatment of its dialysis population, since the inspection of profit-over-people centers is purely tokenal and deliberately ineffective.

The dialysis capitalists often argue that the massively higher death rates among dialysis patients in the US is due to a wider range of sick patients being accepted for treatment in the US in comparison with other countries, but in my experience this is simply not true.  I have been dialyzed in the US, in England, and in Canada, and as a student in Gemany in the 1980s spent three months doing a statistical project at a dialysis center, and the patient population in terms of age and morbidity looks the same everywhere.

Some sample statistics on the dialysis patient death rate in various countries show a 9% rate for Japan, a 13% rate for Canada, and a 24% rate for the US.

[jdbnomad]

I can agree and disagree with many of those statements.  Before I take numbers like that to heart though, I would be interested in if we are comparing apples to apples.  The biggest variables are co-morbidity and admissions practices.  Many people die when renal failure is the last event in a long line of spiraling health conditions.  I have seen a lot of patients come in to clinics that you KNEW dialysis was only a bandaid.  It is so sad but true.  I am not claiming to be an expert on foreign dialysis admissions practices, but to tell me that 1 in 4 dialysis patents die each year in America simply due to the the fact that we have private providers in this country, is a statement I would have to dig into before accepting it at face value.  I am not closed minded and would love to look at any info provided because I am FAR from an expert on all things dialysis. 
I have worked for both For-Profit and Non-For-Profit companies and I can assure you that there are no monsterish cigar chomping industrial fat cats sitting in a high rise office somewhere directing substandard care to squeze an extra penny out of the market share.  This industry is full of some of the most kind and careing people I have ever met in my life.  The facts are, as I understand them, to fill the need for hemodialysis someone has to provide that service.  AS of right now it is private companies because we do not have socialized healthcare.  The lions share of the money comes from medicare who's reimbursement rate has been fixed for over 20 years without even increases for inflation.  All providers have gotten very effecent at giving care so that they can still turn a profit and keep their investors interested.  Has that "effecency" gone overboard at time...yes it has.  I remember sitting at a nurses station in 1989 cutting residual Renalin strips in half lengthways to make 2 strips out of 1 because they were so costly...lol.  Is this a perfect system?...Not at all....are there any perfect systems out there?  I do not think so.  And unless this county decides to scoop up and nationalize all of these private companies we have to work with what we got.  I just don't see the United States goverment doing that because even THEY know that there is no program out there that they have control over that is run well or effeciently.  I would shudder to even think of what would happen with a beuraucraticly run renal network of thousands of individual clinics.

I will go put on my flame retardant jumpsuit and wait for it..LOL...but why even be on this forum if I'm not going to be honest with how I feel.

Wow...i need spell check here...im more of a math guy...got to go...be back later

JDBnomad