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During sit-down rounds in dialysis units, members of the dialysis team typically review each patient's progress, coordinate care among team members, and develop care plans for each patient. Patients with chronic kidney disease who are treated at dialysis units with monthly or more frequent sit-down rounds are 32 percent less likely to be hospitalized, 29 percent less likely to die, and more likely to achieve clinical targets than patients treated at dialysis units with less frequent or no sit-down rounds. That's the conclusion of a study supported in part by the Agency for Healthcare Research and Quality (HS08365).
Sit-down rounds require dedicated time when team members can meet—usually outside regular shifts or when there is a low patient volume—which can be difficult in busy dialysis units that are short-staffed or under financial constraints. Sit-down rounds are not meant to supplant the regular weekly rounds by nephrologists, who assess patients during dialysis treatment, explains Neil R. Powe, M.D., of Johns Hopkins University School of Medicine. Dr. Powe and his colleagues examined whether sit-down rounds improved the outcomes of 644 adult hemodialysis patients from 75 outpatient dialysis clinics in 17 States throughout the United States who survived at least 6 months after study enrollment.
Monthly or more frequent sit-down rounds were conducted in 48 percent of the clinics, representing 45 percent of patients. Patients who were treated at these clinics had nearly twice the odds (odds ratio 1.95) of achieving more of the five performance targets for albumin, hemoglobin, calcium-phosphate product, dose, and vascular access type (fistula). Collaborative discussion of short- and long-term care goals for individual patients during sit-down rounds may have influenced these results.
See "Frequency of sit-down patient care rounds, attainment of clinical performance targets, hospitalization, and mortality in hemodialysis patients," by Laura Plantinga, M.S., Nancy E. Fink, M.P.H., Bernard G. Jaar, M.D., and others, in the December 2004 Journal of the American Society of Nephrology 15, pp. 3144-3153.
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