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Abstract
Objective:
Previous research suggests that erythropoiesis stimulating agent (ESA) administration in dialysis is a time-consuming task and switching to less frequently dosed ESAs may offer operational efficiencies. Our objective was to describe and measure the time spent on tasks in the ESA administration process in US dialysis centers, and to estimate potential efficiency gains of using weekly (QW) administration vs three-times-per-week (TIW) administration.
Methods:
We conducted a time and motion study of staff time required to prepare, administer and document ESA doses. Dialysis centers using intravenous administration of TIW epoetin alfa (EPO) or QW darbepoetin alfa (DPO) were selected in pairs (one EPO, one DPO) from the same organization to help control for differences in ESA protocols and staffing patterns across organizations. ESA-related tasks were timed by trained observers. Time savings of TIW vs QW administration were estimated. Staff were interviewed about alternate activities that could be accomplished if time were saved in the ESA process.
Results:
A total of 200 administrations were observed (81 DPO, 119 EPO). A mean of 2.26 (95% CI: 2.1–2.5) minutes per dose were required for ESA administration. ESA process time per administration did not vary significantly between EPO and DPO (p = 0.83). Estimated potential monthly staff time savings for an average facility of 70 patients totaled 23 hours, due to fewer ESA administrations using QW DPO. Patient education and fulfillment of care plans were identified as opportunities for improved care processes that could be implemented if staff time was freed up from the ESA process.
Limitations:
Results should not be generalized to other countries, ESAs and/or dosing frequencies.
Conclusions:
Switching from TIW EPO to QW DPO can result in time savings due to fewer administrations and provide opportunities to redirect nurse time towards activities aimed at improving patient care.
Transparency
Declaration of funding
This study was sponsored by Amgen Inc. The study sponsor played a role in study design, interpretation of data, and writing of this manuscript.
Declaration of financial/other relationships
J.M.S. has disclosed that he has received consulting fees from Amgen Inc. related to this study. J.P.C. and A.A. have disclosed that they are employees of Amgen Inc. and own stock and/or stock options in Amgen Inc. E.R.A. and J.F.R. have disclosed that they are employees of RJM Group LLC, which received consulting fees for this study. L.C.E. and L.A.S. have disclosed that they are affiliated with Dialysis Center of Lincoln, which was a participating site in this study. They received no direct payment for their participation in the study.
CMRO peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no relevant financial or other relationships to disclose.
Acknowledgments
No other assistance in the preparation of this article is to be declared.