Insourcing and Internal Staff Development to Drive High-Quality, Cost-Effective Care

Background: Improving care quality at lower cost remains at the forefront of healthcare. As US health systems move to in-house dialysis during an ongoing nursing shortage, processes that attract and develop internal nurses are essential to creation of a robust, high quality program. Methods: In 2018, the AdventHealth system (50+ hospitals, 9 states) began conversion from outsourced to insourced dialysis within facilities. AdventHealth Ocala insourced dialysis in June 2020. A standardized model of recruitment and training was implemented to help ensure short- and long-term staff development and program success. The model includes nurse identification, education, training and performance monitoring. Nurse retention, satisfaction, clinical outcomes and financial impact are reported. Results: The AdventHealth Ocala training model is 4-8 weeks. At program launch, 5 nurses were recruited for the nephrology team. The recruiting process targeted nurses with well developed critical thinking from PCU, ICU and Medical Surgical units and a dedicated dialysis leader. Didactic learning included renal anatomy and physiology, basics of dialysis, intradialytic complications, equipment and regulatory compliance. Device training was 3-4 hours conducted by the device manufacturer (Outset Medical) followed by 3 to 4 weeks at sister campuses with experienced nephrology nurses, including vascular access cannulation training. Continued cannulation mentoring was provided by experienced nurses at Ocala. Based on proficiency, new nephrology nurses were cleared by trainers to treat independently between weeks 4 and 8. Over 5 years, staff retention is high with only 2 RN losses (one out of state, one due to physical health). Code Blue in dialysis events/quarter were reduced 94%. There was a marked and sustained reduction in CLABSI (Figure 1). Biannual Glint Surveys revealed >95% dialysis staff satisfaction. Financial analysis demonstrated a 28% return on investment over the first 2 years. Conclusion: Insourcing dialysis provides opportunity for quality and overall care improvement. This structured model for nurse recruitment and training demonstrates effective internal staff development resulting in improved, lower cost care at AdventHealth Ocala. Funding: Commercial Support - Outset Medical