By Bill Peckham
Among my last posts before my blogging break was a series of post in support of incenter every other day dialysis schedules (Part One); (Part Two); (Part Three); (Part Four); (Part Five); (Part Six) EOD was a good Idea then and it is a good idea now, but here we are 6 years later and still EOD schedules remain the unicorns of incenter dialysis.
Except for the handful of programs offering SDHD, all routine incenter hemodialysis schedules include the ‘dialysis weekend’, no matter if the dialysis is being provided through a for profit system or a centrally planned, state owned hospital. The universality of the dialysis weekend gives one pause. Why is it so?
In regards to every other day incenter schedules commenter A. Simon raises two points:
- Would the EOD schedule be disruptive to the lives patients are meant to live when not dialyzing?
- Would EOD be economically viable?
It’s helpful to think in terms of two week periods. Instead of 6 treatments in two weeks, an EOD patient would receive 7 treatments. EOD schedules result in a nontrivial 16.6% increase in the number of treatments delivered (from 6 to 7). Would it be disruptive? It could be certainly but many of us rely on our smart phone’s calendar app to tell us when to be somewhere, routines become routines whether they are in seven or forteen day cycles. I'd guess the amount of disruption caused by EOD schedules would fall somewhere between daily and 3x/week schedules.
As for EOD's economic viability and what percent of a clinic’s census would have to choose EOD schedules for the scheme to work logistically? I wrote a post here; TLDR in the US if a seventh treatment day covered variable cost and contributed something to overhead it would be an economic win. The EOD constraint is: How many patients need to dialyze on Sunday (the seventh day) for it to make sense to open the clinic? Whatever that number is, multiplied by two is how many patients would have to choose EOD. For most units that would mean a minimum of between 25 and 40 patients. For most units.
The exception would be a unit that was already open seven days a week … for instance a unit serving patients with daily dialysis schedules. A unit like those operated by Brazilian Center for Nephrology and Dialysis which operate units 24/7/365. If a unit is already open, why not offer EOD? A unit operating 24/7 would only need pairs of willing patients for an EOD program to operate. EOD is a good value for Patients, Providers and Payers; EOD schedules deserve a chance to prove their value.