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A Dialysis Administrator's Perspective on Vasc-Alert

A Dialysis Administrator's Perspective on Vasc-Alert

We recently had the pleasure of sitting down with Mary Liechty, Dialysis Administrator of Southeastern Renal Dialysis, LC. We wanted to talk with her about how Vasc-Alert has changed her facility's workflow and patient assessment accuracy for the better. Mary has her RN, BSN, CNN, and MBA and uses her vast knowledge and unique skill set to guide her staff to perform a high level of clinical excellence and focus on patient satisfaction. Mary is passionate about Vasc-Alert and the burdens it has lifted from her small, rural clinic.

“With Vasc-Alert the staff don’t have to do anything but their job - caring for patients.”

What were the problems your facility and your patients were facing?

As a small group in rural Iowa, we don’t have access to big centers that have doctors at their fingertips and can get someone in quickly. We have one vascular surgeon for 5 clinics. Those 5 clinics are spread out as far as an hour away from the surgeon’s hospital.

So we were continually trying to do things that were improving the life of the fistula before it wouldn’t work at all. When the fistulas failed, we called the surgeon and usually there was a delay for their access. We had to get a temporary access or lose the access altogether. We saw that happen a lot even though we had tried to add tools. We have a venous pressure monitoring process where we decreased the blood flow rate monitoring the VP, but it still didn’t take into account all of the things that Vasc-Alert does. We added an ultrasound machine that was handheld and very simple, but it still wouldn’t catch a problem prior to the emergency…we just needed something else.

I literally stumbled onto Vasc-Alert when I met a salesperson from a previous career. He just began telling me about it at one of the tradeshows. At that point in time, I don’t even think they had a booth. We continued conversations and I was eager learn more. It just made so much sense. It really excited me to think that we could potentially identify these patients prior to their access stopping function. It gave me hope that we could get them straightened out, so that we don’t lose the time during treatment as a center, and are able to identify problems to the physicians in a timely manner.

Since the implementation of Vasc-Alert, when someone’s access presents issue, the first question is always “What does Vasc-Alert say?”. Medical professionals trust the data. The physicians don’t question it and are able to see them right away. We find that the physical representation always matches the data as well.

“I’m shocked that more people don’t use it.”

What is Coverage V551 and why was it important to your facility?

Our governing body is Medicare or CMS. When you look at vascular access related Vtags, it states that you need a monitoring and surveillance program, but we really weren’t able to have that combination. We were monitoring and our nurses knew how to examine the access and the ultrasound tool that was monitoring. Our surveillance was a venous pressure test, but it was very dependent on the human factor. If the staff forgot to do it, then we didn't have that data. Dialysis facilities are very busy and time is of the essence. You are essentially trying to accommodate 36 patients in about 15 - 16 hours per day, so any manual process that you can automate will save time.

We are staffed well, but a lot of facilities are dealing with staff shortages. Many facilities do not have the amount of staff that we do, so asking them to do an additional task can be difficult. The thing is, with Vasc-Alert, the staff don’t have to do anything but their job - caring for patients. I have to run a couple of reports and send them to Vasc-Alert once weekly, but it takes less than 5 minutes for all of the patients. We are seeing that time constraint is astronomically reduced and the accuracy is much, much greater.

What were the barriers and/or challenges that were present when you identified what you believed needed to happen, but seemed it couldn’t?

I just had to make it fit into my budget. There weren’t any barriers necessarily, we are set up differently as we are not hospital based. Instead, we are owned by 4 hospitals. This means that making the surgeon’s life easier is important for retention. For us, the benefits of Vasc-Alert outweigh the cost. There are far more expensive things than the Vasc-Alert technology. Ultrasound machines, for example, I was able to negotiate down to $10,000 each.

Were staff and other individuals internally accepting of the change immediately? If not, how did you bring everyone on board?

Anytime you have change or have something new, they initially look at it as one more thing to do. At first I had quite a few that might not have added it to their process every day, but once they realized how easy it was, they were focused on learning the software. It took some time and encouragement for the system to work, but overall it wasn’t a difficult process to transition. The process was made even easier when physicians bought in. Vasc-Alert took care of all of the training and education opportunities. They were always very welcoming to new staff and they always make themselves available and are proactive about training or help that we might need.

One thing you have to understand is they are adamant to not take away the physical examination of the access. The physicians trust the data and believe in it, but they aren’t trying to eliminate the in person view of the access. This combination feels healthy and trustworthy

How quickly did you begin to see a change in patient satisfaction and overall results from use of the Vasc-Alert platform?

It was more of a combination of everything that we were doing for access - the patient doesn’t necessarily know if we have it or not unless they hear us discussing the platform. They can actively see our ultrasound machine in use and therefore know about the process. Patient satisfaction comes in when their issues are identified before they become a huge issue and their procedures are more quickly addressed. Staff satisfaction comes from the fact that this algorithm will point them to the issue and alerts from Vasc-Alert that instead of feeling doubted or unsure about the cannulation issue. Vasc-Alert is more identified and specific. We could try and improve cannulation for them instead of guessing, and if the system is telling us they need a referral - it validates that.

Mary Liechty, RN, BSN, CNN, and MBA gave a special presentation titled “Effective Vascular Access Management: An Independent Dialysis Facility’s Journey” to the National Renal Administrators Association 2018 and the National Kidney Foundation in 2019. Recently, she sat down to answer a few questions about how Vasc-Alert has changed her facilities workflow and patient assessment accuracy for the better.