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NDT Advance Access originally published online on January 8, 2008
Nephrology Dialysis Transplantation 2008 23(3):786-788; doi:10.1093/ndt/gfm926
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© The Author [2008]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org


The modern haemodialysis factory: must quality improvement trump personalized care?

David C. Mendelssohn1 and Mark Benaroia2

1 Humber River Regional Hospital and University of Toronto 2 Humber River Regional Hospital, Toronto, Canada

David C. Mendelssohn, Humber River Regional Hospital, 200 Church St. Room 2024, Weston, Ontario M9N 1N8, Canada. Tel: +1-416-243-4368; Fax: +1-416-243-4421; E-mail: dmendelssohn@hrrh.on.ca

Keywords: Continuous quality improvement; haemodialysis; patient satisfaction

The first 150 words of the full text of this article appear below.

Haemodialysis (HD) patients expect and deserve sufficient access to nephrologists, personalized patient-directed care and effective provision of services, as our mentors and role models have taught us [1]. While this may be ideal, it may only be possible in relatively small HD facilities and in home peritoneal dialysis (PD) and HD programs. Most large, modern HD units will face enormous challenges in fulfilling this. Epidemic end-stage renal disease (ESRD) growth rates, in concert with a static number of trained nephrologists, result in an ever-increasing patient-to-physician ratio. Fortunately, technological improvements over the last 20 years have facilitated more efficient management, such that it takes less physician time per patient. However, the size of modern HD facilities often reaches 50 stations or more. This patient volume is outstripping the time efficiencies realized through technology, and causes the HD unit to become more like a factory and less like a health . . . [Full Text of this Article]


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