How we did it: The Kidney Institute; Milwaukee, WI

Six Secrets of Success for Building a Successful PD Clinic

From an Interview with Dr. Dana Campbell, MD, Clinical Nephrologist

"Providing PD and providing hemodialysis are vastly different," says Campbell. Because of that difference, he points out, everything about running a PD clinic is different, too. According to Campbell, physicians who try to offer PD using a hemo model will have a hard time providing good care for their patients and making ends meet. "It isn't easy. It took me 4 years to learn how to get things right," admits Campbell, "but now I know what it takes to build a successful PD program."

Secret 1: separation from hemo

"PD clinics that are offshoots of in-center hemodialysis programs will never grow," observes Campbell. "The needs of the hemo program will always overpower the needs of the PD program because hemo is more acute." To illustrate his point, Campbell likens combining the two kinds of programs to combining rehab and the ICU in a hospital. It can't work, he claims, because the care models are so different.

A successful PD program must stand on its own.

Secret 2: committed nurses

"PD nurses are special people," notes Campbell. "They are nurturing, caring people who like doing the teaching, follow-up and hand-holding that PD patients require." Campbell gives much of the credit for the success of his PD clinics to the nurses. "They can handle almost anything," he says, "and, they love what they do."

"You can't be successful without a committed team of PD nurses."

Secret 3: regular monitoring

Campbell believes that a successful PD program must factor in the need for intensive patient follow-up. "If you just do the training and send the patients home, you're going to have problems," he warns.

New patients need regular monitoring until they are stable and comfortable with the therapy. Some patients—those with heart failure, for example—may need daily phone calls to help them stay on track.

In Campbell's PD clinics, time is allocated for nurses to do a lot of follow-up. "We allow our nurses the time they need to provide good care. Even though the time is not always reimbursed, it is time well spent," claims Campbell.

A successful PD program provides plenty of one-on-one patient monitoring.

Secret 4: 24/7 availability

To be comfortable at home, PD patients must know that they can call the center with any problems. A successful program will provide the staff resources for on-call coverage 24/7, and will also work to build trusting relationships with patients. "Patients have to feel that they can call," explains Campbell. "If they don't, problems can develop."

A successful PD program makes it easy for patients to call for help.

Secret 5: acute care back-up

Campbell and his staff work with local hospitals to make sure that PD patients who are hospitalized receive proper care. "We visit the hospitals and work with them to 'certify' certain staff members to do exchanges and set-ups," explains Campbell. He believes that planning for acute care back-up is a prerequisite if a PD program is going to grow. "Physicians will not put their patients on PD if they do not feel comfortable that they can get appropriate care in the hospital," he adds.

A successful PD program ensures that proper care is available in acute care settings.

Secret 6: a complete package

According to Campbell, PD programs cannot succeed unless all the pieces are in place to grow the number of patients and provide good care. "A PD program with only 15-20 patients is not viable," claims Campbell. "To be successful, you have to set up a PD program to grow."

Growth will not just happen, however. Based on his experience, Campbell believes that growth will only come as the result of a proactive, planned approach to PD. "If you start out tentatively, with a wait-and-see attitude and doubts about the potential for success, your expectations will be fulfilled," predicts Campbell, " and your program won't grow beyond 10% of your patients."

A successful PD program needs all the elements of success in place from the start.

Today, Campbell sees a renewed interest in PD, but believes that years of disinterest in PD have left many nephrologists unfamiliar with proper protocols and business models. With his consulting group, The Kidney Group, Campbell and his partners offer the opportunity for nephrologists to work with experienced practitioners while offering more patients the option for home therapy.

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