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The Outpatient Dialysis Access Center

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Hemodialysis Access

Abstract

The outpatient dialysis access center (DAC) is an example of the increasingly more cost-effective and collaborative model of healthcare. The outpatient DACs focus on a more patient-centered facility results in a place where there is more time dedicated to care and service. Since patients come to the outpatient DAC from several points in the healthcare system, it provides an ideal location to offer coordinated, comprehensive access care. Costs to the system are fixed, and the financial risk of the care delivered is taken on by the provider. Costs are not compromised at the expense of safety or quality. Improved efficiency and better outcomes are seen in treating both elective and emergent dialysis access issues in the outpatient setting. These centers obviate the need for the hospitalization of many access-related issues. Appropriate patient selection and monitoring combined with procedural planning and vigilant care allow for the safe and successful performance of interventions. This chapter provides an overview of DACs and details the importance of patient selection in these facilities.

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References

  1. Nadolski G, Praestgaard A, Shiansky-Goldberg RD, et al. Medical emergencies and cardiopulmonary arrests in interventional radiology. J Vasc Interv Radiol. 2013;24:1779–85.

    Article  PubMed  Google Scholar 

  2. Beathard GA, Litchfield T, Physicians Operators Forum of RMS Lifeline, Inc. Effectiveness and safety of dialysis vascular access procedures performed by interventional nephrologists. Kidney Int. 2004;66:1622–32.

    Article  PubMed  Google Scholar 

  3. Rueb GR, Brady WJ, Gilliland CA, et al. Characterizing cardiopulmonary arrest during interventional radiology procedures. J Vasc Interv Radiol. 2013;24:1774–8.

    Article  PubMed  Google Scholar 

  4. Urbanes AQ. Dialysis access procedures in the outpatient setting: risky? J Vasc Interv Radiol. 2013;24:1787–9.

    Article  PubMed  Google Scholar 

  5. Zhang H, Schaubel DE, Kalbfleisch JD, et al. Dialysis outcomes and analysis of practice patterns suggests the dialysis schedule affects day-of-week mortality. Kidney Int. 2012;81:1108–15.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Dobson A, El-Gamil AM, Shimer MT, et al. Clinical and economic value of performing dialysis vascular access procedures in a freestanding office-based center as compared with the hospital outpatient department among Medicare ESRD beneficiaries. Semin Dial. 2013;26:624–32.

    Article  PubMed  Google Scholar 

  7. Arnold WP. Improvement in hemodialysis vascular access outcomes in a dedicated access center. Semin Dial. 2001;13:359–63.

    Article  Google Scholar 

  8. Kian K, Takesian K, Wyatt C, et al. Efficiency and outcomes of emergent access procedures performed at a dedicated outpatient vascular access center. Semin Dial. 2007;20:346–50.

    Article  PubMed  Google Scholar 

  9. Mishler R, Sands JJ, Ofsthum NJ, et al. Dedicated outpatient vascular access center decreases hospitalization and missed outpatient dialysis treatments. Kidney Int. 2006;69:393–8.

    Article  CAS  PubMed  Google Scholar 

  10. Jain K, Munn J, Rummel M, et al. Future of vascular surgery is in the office. J Vasc Surg. 2010;51:509–14.

    Article  PubMed  Google Scholar 

  11. Jackson JW, Lewis JL, Brouillette JR, et al. Initial experience of a nephrologist-operated vascular access center. Semin Dial. 2000;13(6):354–8.

    Article  CAS  PubMed  Google Scholar 

  12. Petrusky L, Friedman A, Miller G, et al. Suggested guidelines for performing procedures in patients with chronic kidney disease in outpatient centers. Semin Dial. 2011;24:18–21.

    Article  PubMed  Google Scholar 

  13. Hellinger JC, Kassam Z, Mendelson N. Outpatient hemodialysis vascular access: cost-efficient clinical care. Appl Radiol. 2014;43:52–4.

    Google Scholar 

  14. Wells AC, Fernando B, Butler A, et al. Selective use of ultrasonographic vascular mapping in the assessment of patients before hemodialysis access surgery. Br J Surg. 2005;92:1439–43.

    Article  CAS  PubMed  Google Scholar 

  15. CMS website. CY2015 OPPS Addendum B http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates-Items/2015-Jan-Addendum-B.html.

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Correspondence to Deepak Nair MD, MS, MHA, RVT, FACS .

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© 2017 Springer International Publishing Switzerland

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Nair, D. (2017). The Outpatient Dialysis Access Center. In: Shalhub, S., Dua, A., Shin, S. (eds) Hemodialysis Access. Springer, Cham. https://doi.org/10.1007/978-3-319-40061-7_43

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  • DOI: https://doi.org/10.1007/978-3-319-40061-7_43

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-40059-4

  • Online ISBN: 978-3-319-40061-7

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