Demand for Dialysis Prompts Innovation at UH Geauga Medical Center

UH Clinical Update | October 2022

The pandemic put unprecedented pressure on patients requiring dialysis and the healthcare workers who care for them. With an influx of COVID-19 patients in the ICU requiring dialysis for kidney failure, other patients requiring maintenance dialysis for end-stage kidney disease sometimes encountered delays, given that standard machines can only accommodate one person at a time.

What’s more, dialysis nurses have logged untold hours of “windshield time,” traveling from hospital to hospital to care for their patients and meet demand, often late into the evening. In short, demand for life-sustaining dialysis service has severely challenged hospitals’ ability to provide it.

A better way: At UH Geauga Medical Center, nephrologist Renato Roman, MD, came up with a proposal to alleviate dialysis staffing shortages and improve patient access. With the approval of hospital leadership, he worked with ICU nurse manager Rick Keleman to train 27 ICU nurses to use an easy-to-learn and easy-to-use machine called the Tablo® Hemodialysis System for their patients requiring dialysis.

In the ICU, two or three Tablo machines with a simple interface can be going at once under the supervision of an ICU nurse, freeing up dialysis nurses to care for their patients using standard machines. Even now that the pandemic is winding down, the benefits of these self-contained machines to UH and its patients remain.

Tablo machines are in use at UH Geauga, as well as at UH Cleveland Medical Center and UH Samaritan, Dr. Roman says.

Award-winning Innovation

“It helped a lot and it is still helping a lot,” he says. “The patients who need dialysis who are in the ICU are being dialyzed by the ICU nurses using Tablo. That frees up the dialysis staff to do other patients. If they are able to finish their floor dialysis patients sooner, they can go to the next hospital to help out.”

Dr. Roman was recently recognized for this innovation by UH CEO Cliff Megerian, MD, FACS, Jane and Henry Meyer Chief Executive Officer Distinguished Chair, with a “Dinner with the Doc” honor.

Other Benefits of Tablo

Beyond the staffing benefits, Tablo machines are also well-suited for the severity of illness seen in ICU patients, who may be struggling with sepsis or low blood pressure in addition to kidney failure, Dr. Roman says.

“With the Tablo, you can actually program the dialysis so that it is even more gentle,” he says.

This, in turn, can help prevent unnecessary and disruptive transfers to UH Cleveland Medical Center for continuous renal replacement therapy (CRRT) – a slower type of dialysis for severely ill patients that puts less stress on the heart.

“By having the Tablo in our hospital here at UH Geauga, it can be programmed to be almost as gentle as CRRT at Main Campus,” Dr. Roman says. “In fact, studies have shown that there is not much difference in the outcomes or hemodynamic stability between CRRT and sustained low efficiency dialysis with Tablo.”

What the Future Holds

Dr. Roman says he doesn’t expect Tablo machines to replace standard dialysis machines anytime soon, although they are becoming popular in many hospitals. Standard dialysis machines work well for patients who have a stable pumping heart and good circulation.

But he says Tablo is a great option in the ICU. Already at UH Geauga, the hospital has seen improvements in costs and length of stay linked to this innovation.

“By offering Tablo services, UH Geauga hospital has been able to start dialysis immediately, alleviating delays in care related to dialysis nurse/tech staffing,” says Marlea Miano, MD, Chief Medical Officer at UH Geauga. “This has contributed to some reductions in length of stay. Additionally, Tablo allows patients that might have been transferred for CRRT to stay close to home. Dr. Roman is an advocate for value. He thoughtfully spoke up for a service that met and likely surpassed the needs of our patients and the hospital as a whole.”

For his part, Dr. Roman credits the success of the project to his colleagues at UH Geauga.

“The reason this is successful is really the support from the nurses,” he says.

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