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Outpatient Dialysis - Department of Nephrology

Goals and Objectives

Outpatient Dialysis:

The objectives, methods, expectations, supervision and evaluation for the Outpatient Dialysis rotations at LUMC and Edward Hines Jr. VA Hospital are the same and include the following:

Specific Objectives:

• Obtain the knowledge and skill necessary to manage patients on chronic dialysis therapies.

• Achieve the knowledge and skills necessary to function as the medical director of a dialysis unit. This includes technical

knowledge, management skills, business issues and quality assurance techniques.

• Become competent in assessment of system-based problems and solutions specific to dialysis services.

• Learn self-assessment based on well defined outcome monitors.

Methods:

• Routine rounds on all chronic hemodialysis patients at the LUMC/VA

• Management of acute problems of patients at the LUMC/VA

• Participation in peritoneal dialysis clinics at VA and/or LUMC dialysis unit

• Participate in monthly patient care conferences with nursing staff, social worker and dietician at

the VA and LUMC.

• Provides physician support as needed to the pre-ESRD program at the VA and or LUMC dialysis units.

• Routine rounds on a specific shift at LUMC Dialysis Unit for the two years of fellowship functioning as the primary

nephrologist under supervision.

• Participate in Quality Assurance activities at the dialysis centersas appropriate.

ACGME
Competencies / 1st Year / 2nd Year
Patient Care /
  • The fellow will develop the necessary clinical skill to care for chronic dialysis patients.
  • Patients will be treated with respect and compassion.
/
  • The fellow will achieve desired treatment goals on dialysis patients using state of the art practice.

Medical Knowledge /
  • The fellow will gain all necessary knowledge and skills to care for chronic patients on hemodialysis and peritoneal dialysis
/
  • The fellow will broaden the knowledge of the technical and administrative aspects of the dialysis center in preparation for a role as medical director.

Practice-Based Learning and Improvement /
  • Learns from self evaluation of outcome monitors.
/
  • Develops effective methods of patient management based on evaluation of outcome monitors.

Interpersonal and Communication Skills /
  • Effectively communicates with chronically ill patients and the treatment team.
/
  • Develops methods to win patient compliancewith treatment and staff participation in treatment goals.

Professionalism /
  • Develops good relationships with the treatment team (nurses, technicians, dieticians, social workers and administrative staff) of the dialysis center.
/
  • Leads the treatment team effectively and
assumes responsibility fordecisions.
System-Based Practice /
  • Learn to identify system problems that increase the risk for error.
/
  • Develops systems to improve outcome and reduce errors in thedialysis unit.

Attending Supervision:

An attending physician that is a member of the LUMC nephrology faculty is assigned at all times to provide supervision for the nephrology fellows on this clinical rotation. Scheduled supervision occurs at regular intervals and additional direct or telephone supervision is provided as the clinical activities and teaching require. The supervisory methods include:

• Examination and discussion of each dialysis patient.

• Concurrent review of each dialysis patient’s orders and progress as planned by the nephrology fellow.

• Oversight of the fellow’s management of complications of dialysis on a day to day basis.

Evaluation:

• Attending evaluation forms by LUMC/VA attending physicians.

• Staff Survey as part of the 3600 evaluation by professional associates

• Each fellow will be evaluated to determine compliance with KDOQI guidelines. This will be

used as a means of self evaluation for the fellow.

Facilities:

• There are two Dialysis Centers. One is a 34 station dialysis unit and the second a 30 station

dialysis unit.

• Each unit is staffed with administrators, nurses,technicians, social workers and dieticians.

• The equipment and dialysis practices are state of the art.

A more detailed description of the outpatient dialysis rotations may be found in Renal fellowship guidelines manual.