Health care silos — which block communication between emergency departments, primary care practices, dialysis units and other functions — are bad for patients and society. They inhibit coordinated care which contributes to high costs and poor outcomes. This is particularly evident in the management of end-stage renal disease (kidney failure) where potentially fatal complications that good coordination could head off are common. Doctors and nurses at Brigham and Women’s Hospital in Boston have developed a care-coordination program for ESRD patients that is reducing hospital and emergency department visits, helping patients get needed kidney transplants and saving large amounts of money.
A patient we’ll call Bonnie has been on dialysis for five years, making the difficult trip three times a week to a clinic to sit for hours hooked up to a machine that filters toxins from her blood. Bonnie is 65 and suffers from end-stage renal disease (ESRD), the gradual failure of her kidneys. She has chronically low blood pressure, which complicates the dialysis, and ingests a lot of salt which causes weight gain between treatments. Often, she wakes up breathless and ends up in the emergency department. The ED and dialysis unit don’t have a shared electronic health record, and on discharge there is little communication between the two sites about her care. Nor is there communication between the dialysis unit and her primary care doctor (PCP). When she’s hospitalized, her medications are sometimes changed, but that critical information often doesn’t get back to her many providers. Bonnie is hoping for a kidney transplant, but she doesn’t know where to start, and she has yet to undergo an evaluation to see if she’s eligible.
