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Patient care technicians improve haemodialysis patient outcomes

Presented by
Dr Laura Plantinga, Emory University, GA, USA
ASN 2023
Having fewer patient care technicians (PCTs) for every haemodialysis patient is associated with increased mortality and hospitalisation, and decreased incidence of kidney transplantation.

PCTs are pivotal in dialysis care. They operate haemodialysis machines with prescribed treatment parameters, manage cannulation, and monitor vitals. Turnover and variation in the number of PCTs on site can compromise consistent, high-quality care.

Dr Laura Plantinga (Emory University, GA, USA) presented the results of a retrospective cohort study that assessed the association of patient:PCT ratios with health outcomes within 1 year of starting in-centre haemodialysis [1]. The data was accessed from the United States Renal Data System (USRDS), and it included 200,863 patients who started in-centre haemodialysis from 2016–2019 and received haemodialysis for a minimum of 90 days. The mean age was 63 years. Patient:PCT ratio was calculated by dividing the total number of patients receiving in-centre haemodialysis by the number of full-time equivalent PCTs reported on the last day of the year prior. Outcomes included mortality, first transplantation, first all-cause hospitalisation, and first hospitalisation caused by sepsis, fluid overload, or vascular access.

The quartile of patients with the highest patient:PCT ratio had an increased incidence of mortality (IRR 1.07; 95% CI 1.02–1.12; P<0.001), all-cause hospitalisation (IRR 1.05; 95% CI 1.02–1.08; P<0.001), fluid overload hospitalisation (IRR 1.05; 95% CI 1.02–1.08; P<0.001), sepsis hospitalisation (IRR 1.08; 95% CI 1.03–1.14; P<0.001), and vascular access hospitalisation (IRR 1.15; 95% CI 1.03–1.28; P<0.001). Overall, this quartile had a decreased incidence of transplantation (IRR 0.80; 95% CI 0.71–0.91; P<0.001).

Dr Plantinga concluded that β€œdialysis PCTs may play an important – and often overlooked – role in the quality of care delivered to US patients receiving in-centre haemodialysis. Increased PCT patient loads may result in worse patient outcomes.”

  1. Plantinga L, et al. Higher Patient-to-Patient Care Technician Ratios Associated with Worse Outcomes Among US In-Center Hemodialysis Patients. TH-OR45, ASN Kidney Week 2023, 2–5 November, Philadelphia, PA, USA.


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