A retrospective study of problems with physicians, experienced by patients undergoing haemodialysis, in an Internal Medicine Service

Abstract

Objectives and Methods: A retrospective study in patients with end-stage renal disease
(ESRD) in haemodialysis, was carried out in our Internal Medicine Department. Our goal
was to analyse the reasons for hospital admission and the impact that these patients represent in terms of bed occupation.
Results: During the 15 months’ timeframe 4.5% of the hospitalisations in the department were due to patients with ESRD, 49.7% of whom underwent haemodialysis. In the haemodialysed
patients 26.0% started haemodialysis during hospitalisation and in 19.2% there was loss of
vascular access. The studied group’s mortality rate (MR) was 23.3% (Department MR: 8.9%)
and the average length of stay (LOS) was 16.4
days (Department LOS: 9.8 days). In the patients with loss of vascular access, the MR was
33.3% and LOS was 24.7 days. In those who started haemodialysis in hospital, the MR was 21.1%
and the LOS was 23.4 days. Among the factors contributing to the increased length of stay were
delays in the programming, execution and revision of vascular access by medical and surgical sub-specialities. In 71.4% of patients with loss of vascular access the delay in the construction of vascular access was greater than a
week and in 57.1% this delay exceeded two weeks. In the patients with inaugural haemodialysis, these values were 64.3% and 28.6%.
Conclusion: Patients with ESRD on haemodialysis impose a substantial load on Internal Medicine Departments. There are difficulties in the articulation with sub-specialities, with negative clinical and financial consequences. These
faults need correction, namely through the establishment of multidisciplinary approach protocols.