P1553QUESTIONNARIE-BASED SURVEY ON PRACTICE PATTERNS OF INPATIENTS WITH HEMODIALYSIS AT ALL 42 NATIONAL HOSPITALS IN JAPAN
Authors: Nakata Takeshi , Kamijo Yuji , Konta Tsuneo 
Published: June 2020

Abstract

Background and Aims
General physicians reportedly play an essential role in improving inpatient care. Hemodialysis (HD) management physicians are expected to become “hospitalists” for managing HD inpatients. However, the actual clinical practice patterns of HD inpatients management are not well known.

Method
To clarify the actual clinical practice patterns of inpatients with HD, we conducted a questionnaire-based survey among HD management physicians who worked at the HD centers of 42 national university hospitals in Japan. These universities are members of the “Council of Blood Purification Division in Japanese National University Hospitals.” This survey investigated the affiliations of each HD management physician and their clinical management of inpatients under the care of other departments, via online correspondence or letters. We asked questions about (1) the department managing the HD center; (2) physicians’ experience (by 5 years); (3)working style (full time or part-time); (4) management policy of each facility; (5) how to communicate with other department doctors; (6) how often are laboratory data checked; (7) how often are chest X-ray data checked; (8) how often do they advise doctors from other departments regarding fluid, medication, and nutrition; (9)what do they think about the importance of physicians’ involvement in HD management; and (10)do they find it difficult to manage HD inpatients under the care of other departments. We analyzed whether these aspects were influenced by physicians' experience or department or working style via statistical analysis. We used the linear regression model, Fisher’s exact probability test, or Chi-square test as appropriate. The ethics committee of Oita University approved this survey.

Results
Thirty-seven of 42 facilities(90%) and 173 of 249 HD management physicians (69%) answered this survey. Furthermore, 31 HD centers (84%) were managed by the physicians from a single department (Nephrology = 24, Urology = 6, Emergency = 1), whereas 6 HD centers (16%) were managed by the physicians from two departments (Nephrology and Urology = 5, Nephrology and Emergency = 1). Besides, 87% of HD management physicians were aware of the importance of medical intervention by HD specialists on HD inpatient management. However, only approximately 10% of HD management physicians regularly performed blood examination and chest X-ray for managing the HD inpatients under the care of other departments, whereas 70% of physicians only performed the tests when necessary. Even in the same hospital, the management policy differed among individual physicians. Only 28% of facilities had a shared management policy among physicians. The physicians with little experience faced more difficulty in managing HD inpatients than experienced physicians ( with five years of experience; |r| = 0.75, p &lt; 0.05). The main reason for this difficulty was poor communication with attending physicians, lack of management rules, and short duration of hospital stay.

Conclusion
The clinical practice patterns of HD inpatient management who were under the care of other departments were different for each HD management physician. The physician’s clinical experiences might affect the outcomes of HD management. In addition, good communication and established HD management rules between departments appear to be important.