A comparative risk assessment of dialysis care processes in the home and hospital care contexts
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ORIGINAL ARTICLE
A comparative risk assessment of dialysis care processes in the home and hospital care contexts Peter Chemweno1
•
Liliane Pintelon2
Received: 18 September 2019 / Revised: 25 July 2020 The Author(s) 2020
Abstract Dialysis processes within the home care context is associated with risk factors which are not very prominent in the hospital context. This includes risk factors such as unanticipated device malfunction, or erroneous operation of the equipment, which exposes the patient to injury while undergoing dialysis. Importantly, the mentioned risk factors are further attributed to technical aspects such as suboptimal equipment maintenance or following improper clinical procedures when administering care to the patient. Hence, it is important to follow a methodological approach to identify and assess hazards embedded within the dialysis treatment process, and on this basis, formulate effective strategies to mitigate their negative consequences on patient safety. This paper presents a comparative risk assessment for in-hospital versus in-home dialysis care. For the two cases, the risk assessment considers expertise of care givers involved in administering dialysis. The findings show that performing risk assessment for hospital environment, is more structured owing to expertise of clinicians and care givers responsible for administering dialysis. However, assessing risks for the home-care environment is more challenging owing to absence of domain knowledge, hence a survey approach to structure the risk assessment
& Peter Chemweno [email protected] Liliane Pintelon [email protected] 1
Department of Design, Production and Management, University of Twente, Drienerlolaan 5, 7522 NB Enschede, The Netherlands
2
Department of Mechanical Engineering, Centre for Industrial Management, KU Leuven, Celestijnenlaan 300 A, 3001 Heverlee, Belgium
process is necessary. Moreover, risks in the home care context is influenced by logistical aspects, and lack of domain knowledge for maintaining dialysis equipment. Overall, insights from the comparative studies yields important learning points expected to improve dialysis care as more healthcare providers transfer care to the home environment. Keywords Risk assessment Patient safety Medical devices Technical risks Operational risks Mitigation strategies
1 Introduction Clinical treatment and diagnostic processes often vary in complexities depending on the nature of patient pathologies (Chemweno et al. 2016a, b). Hence to support such processes, different resources are required along the patient’s care pathway, while administering dialysis treatment for patients with kidney diseases (Chemweno et al. 2014). Moreover, with advances in technology and treatment protocols, administration of dialysis is shifting from the hospital, to the home environment. Here, patients increasingly access point-of-care devices for self-diagnosis, and portable dialysis equipment for use at home. However, a shift from the hospital to the home care environment po
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