Patient Scheduling

I schedule my next round of patients 45 minutes after the first person gets off treatment. This allows for stripping, cleaning, priming, and alarm testing for the next patient going on.

If the first shift patient is bleeding longer than anticipated, we simply pull their chair out and stick them in a "triage" area and put a new chair in their spot. We have 3 extra chairs in the unit.

This method prevents us from being held up.

We give 30-45 minutes to get the pts machine set up/tested ect., but we have no extra chairs unless a patient decides they don't want to come or they were hospitalized.

Our schedule is a disaster. With pts ranging from 3-4.5 hours, you are always going to have 2 coming off at once, or one coming off while you want to put someone else on! It gets pretty frustrating for all of us. no matter how we shuffle people around and try to start early in the morning and help eachother out and utilize our 4 empty chairs, 8 times out of 10 we are screwed.

Today for example. First one came off. I was able to re-do the machine and had everything set to go, even had my tape torn! By the time that second patient was in the chair and ready to go, RIIIING! another one starts to come off. Then another one on her heels. Then the third one. So I've got 3 patients holding, one lady ready to get on, and 3 tested, but dirty machines! What do I do?!!

Put on first one.

Get rid of the other 3.

Strip, clean, restring 3 machines, all in a row.

Bring in all 3 patients together and put them on one after the other after the other.

Forget to do my vitals on first pt for an hour.

At the end of the day, they come off within 7 minutes of eachother. Lovely.

Now that's what I call a turnaround!

Our turnover is a mess too. 26 pts out and 26 in over a span of 2 hrs. Everyday is a nightmare. We have a lot of staff, but it's still stressful.

A lot of people want to put the long tx on first, but I think it works better to put short pts on first- for example- say on your first & second shifts a single pod has one 3 hr pt, two 3.5 hr pts and one 4 hr, and your you can do it like this:

(Each of the dash marks "-" represents a 7.5 minute increment of time)

1st shift ______________________________________________2nd shift

Chair 1) 0600 3.0 hr pt on- off @ 0900---- 0930 4.0 hr pt on- off @ 1330

chair 2) 0615 3.5 hr pt on- off @ 0945---- 1015 3.5 hr pt on- off @ 1345

chair 3) 0630 3.5 hr pt on- off @ 1000---- 1030 3.5 hr pt on- off @ 1400

chair 4) 0645 4.0 hr pt on- off @ 1045---- 1115 3.0 hr pt on- off@ 1425

If you have a third shift, do it the same way- allow 30 mins from the time you take a 2nd shift pt out of a chair before you put a 3rd shift pt in it.

By putting a short tx pt on first in chair #1, you can have that pt off, machine stripped re-set up and the 4 hr second shift pt on before the next first shift pt comes off. Then, take off pt in chair 2, then 3. Set up those machines for the nerxt pts- but if you have some time left over do not put the 2nd shift pts on early- that will mess everything up. Then take the pt in chair 4 off, reset up, and put the second shift chair 4 pt on.

If you have a nurse who is doing assessments, verifying bath/dialyzer/machine settings, making tx decisions and giving meds, but not putting pts on in the morning, a schedule like this will give her time to give a few meds between pre-assessments.

For example, if you have four pods of four pts each, each pod will have an 0600 pt, and 0615 pt and so on. It also helps a lot if you do not let the pts on the floor until their put on time. For instance- @ 0550, let in the four 0600 pts- and not anyone else- close the lobby door. When those pts are on, let the 0615 pts in- but no one else, and so on.

Also- it helps to use the pts' behaviors in the schedule. If you have a pt who is always late for his tx and throws the schedule off, change your schedule with this in mind- change the pt's time to the next later time on- but do not tell the pt. This way, when the pt shows up "late" he will really be on time. :)

Same thing goes for if you have a pt who always shows up early, and is pressuring staff to put him on early- change his time to an earlier time.

Thanks Valerie for the detailed reply. We basically do all that you mentioned. Problems arise because there are so many variables with dialysis. A pt who is not normally late, arrives late. A system may clot for whatever reason, and a new setup takes a staff member away from a takeoff, etc, etc. If it is a busy clinic, which mine is, then we anticipate a crazy turnover. If it goes smoothly then it is a pleasant surprise. We are constantly trying to improve our turnover. This is the reality of outpatient dialysis.

Let some patients in and not others? Haha, have you met my patients?

They remind me of zombies in the morning, pacing around the lobby, peering in the windows, drooling at the thought of getting on early.

They'd rather all come in at once, then sit there at wait. Staring at me.

But that's dialysis.

Sounds exactly like my clinic. I like the "drooling to get on early". Yeah, that's dialysis.

Let some patients in and not others? Haha, have you met my patients?

They remind me of zombies in the morning, pacing around the lobby, peering in the windows, drooling at the thought of getting on early.

They'd rather all come in at once, then sit there at wait. Staring at me.

But that's dialysis.

LOL!! Then curse at you when you dont get them on early.

Scheduling is a nighmare. In the example schedule how do you take a pt off at 10 am & have another one going on at 10:15 in a different chair within the same pod? This is the issue we have with our clinic, there are no extra hands to help tear down, set up etc. Each tech must be able to function on their own in their section of four. We have 1 RN & 3 techs for 12 stations. There is no one to answer the phone which is always ringing off the hook. The techs come in & work off the clock in the morning just to get everything done before the patients go on. (this is another topic all together), management told the staff they could not clock in that early. There is no time for breaks or lunch we are lucky to go to the BR once a shift (really sucks when you have your monthly visitor). Please any scheduling ideas would be appreciated. How do other clinics get everything done in the am & how long do you have to complete everything? (machine set ups, water checks, mixing bicarb etc). Mgt feels it can all be done in 45 minutes, but if we get behind in the am the rest of the day it is he!!. This is why they come in early. I wish management would do this job for 1 day. HELP.

It is a nightmare! I used to go in early, but decided to stop. I too wish management had to do this job for one day. Every day is physically & mentally exhausting. Don't know how much more I can take.

Scheduling is a nighmare. In the example schedule how do you take a pt off at 10 am & have another one going on at 10:15 in a different chair within the same pod? This is the issue we have with our clinic, there are no extra hands to help tear down, set up etc. Each tech must be able to function on their own in their section of four. We have 1 RN & 3 techs for 12 stations. There is no one to answer the phone which is always ringing off the hook. The techs come in & work off the clock in the morning just to get everything done before the patients go on. (this is another topic all together), management told the staff they could not clock in that early. There is no time for breaks or lunch we are lucky to go to the BR once a shift (really sucks when you have your monthly visitor). Please any scheduling ideas would be appreciated. How do other clinics get everything done in the am & how long do you have to complete everything? (machine set ups, water checks, mixing bicarb etc). Mgt feels it can all be done in 45 minutes, but if we get behind in the am the rest of the day it is he!!. This is why they come in early. I wish management would do this job for 1 day. HELP.

It is illegal to work off the clock. Simply said!

The management should be telling their employees not to be at work doing work without being on the clock.