T JENNINGS1, E TAN1,2
1Renal Service Bay Of Plenty District Health Board, Tauranga, New Zealand; 2Renal Service, Waikato District Health Board, Hamilton, New Zealand.
Aim: To analyse the impact of wasted/unused Satellite Haemodialysis Unit (SHU) slots.
Background: The Tauranga SHU is run by Registered Renal Nurses (RRNs) with tertiary-based nephrologist supervision. Vacant Dialysis Slots (VDS) arise from hospitalisation, patient non-attendance or delayed/non-allocation (after death, transplantation or relocation). Resources are wasted and other patients are deprived of these slots. With limited SHU capacity, determining the extent of wasted/unused slots is important.
Methods: Data was retrospectively collected using electronic and hardcopy records. Haemodialysis patient attendances for 2016 were analysed, looking at VDS and efforts to fill them (by swapping patients and/or dialysing holiday patients). Slot-wastage was expressed as extent of patient slot-deprivation, nursing/patient ratios and dialysis reimbursement loss.
Results: 4178 (95.04%) out of 4396 Total Dialysis Slots (TDS) were utilized, with NZD$401.93/slot reimbursement (NZD$554.14/holiday slot) and requiring 6.4 Full-Time Equivalent (FTE) RRNs (average salaries NZD$66219.46/annum). There were 229 VDS (5.20% TDS), due to: hospitalisation (93, 41%), non-attendance (49, 21%) and non-allocation (87, 38%). Only 11 slots (4.80% VDS) were filled last-minute (7 swaps and 4 holiday slots); all from predictable hospitalisations and non-allocations. No non-attendance slots were filled. 218 slots (4.96% TDS) were unused/wasted; 1.38 FTE patients could have been accommodated (each FTE requiring 157 slots/year). This amounts to wastage of RRN FTE: 0.31 (using nursing/patient ratios) or 1.32 (using salaries/dialysis reimbursement ratios). Equivalent lost dialysis reimbursement: NZD$87620.74/annum (normal slots) or NZD$120802.52/annum (holiday slots).
Conclusions: There is sizable dialysis slots wastage expressed as patient-slot deprivation, nursing FTEs and reimbursement loss. VDS allowed for flexibility. But predictable vacancies were rarely filled. Avoidable non-allocation comprises a large proportion (38%) of slot-wastage. Efficient utilisation of these slots with speedy slot-allocations could reduce slot wastage.