Using Encrypted Messaging to Evaluate Transitions of Care Between an Outpatient Hemodialysis Center and Tertiary Care Hospital

Background: Hemodialysis (HD) patients face increased risk of adverse events and hospital readmissions during care transitions due to dialysis treatment complexities, access issues, and medication management. Currently, no standardized communication protocol exists for providers (physicians, DOs, ACPs) exchanging critical patient information between hospital and HD facilities. We hypothesize that a standardized messaging procedure could improve hospital to HD center care transitions and information flow with the goal of improving patient safety. Methods: A Microsoft Teams group chat was initiated between a single outpatient HD center and a tertiary care hospital where all nephrology providers (attendings, fellows, ACPs, nurse managers) were included. Messages were sent regarding all in-center and home hemodialysis patients of the outpatient HD center who were sent to the hospital and patients being discharged from the hospital and returning to the HD center. Data regarding the patients’ hospital stay and return to the HD center were recorded and analyzed for a total of 6 months, July-December 2024. Results: A total of 41 patients were recorded during the 6-month period, with 50 total transition messages. Of the 41 patients, 9 (22%) of them contained both messages sent from the HD center and from the hospital. Additionally, 13 (50%) of the messages sent from the outpatient HD center were acknowledged by the hospital inpatient team. Conversely, 18 (75%) of the messages sent from the hospital were acknowledged by the outpatient center. Of the messages sent from the hospital to the HD center, 23 (95%) of them included a hospital course, 17 (70%) included HD access complications, 12 (50%) of them included medications changes, and 7 (29%) included volume status assessments. Conclusion: The lack of standardized communication between hospital and hemodialysis (HD) centers compromises safe transitions of care. Implementation of a standardized message template distributed to all nephrology providers could mitigate transition related adverse events. Hospital discharge communications should consistently document HD access complications, medication changes, and volume status assessments. Provider acknowledgment of these communications is essential to ensure patient safety during transitions.