Direct costs of integrated procedures of conventional hemodialysis performed by nursing professionals.
Antônio Fernandes Costa Lima
PMID 30020331WHAT IT FOUND
Direct costs of hemodialysis procedures done by nursing staff came mainly from materials and solutions, not nurse time.
Catheter access procedures cost more than fistula access procedures.
Key findings
01The weighted mean direct cost of the hemodialysis procedures studied was US$26.59 in hospital A, US$38.96 in hospital B and US$27.68 in hospital C.
02For preparing the hemodialysis machine, total mean direct cost was US$22.20 in hospital A, US$32.60 in hospital B and US$20.30 in hospital C, with material cost the most striking component in hospital B (US$24.10).
03Installing dual lumen catheter access cost the most in hospital C, with a mean total direct cost of US$7.49 and mean material cost of US$4.41.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study measured only direct costs; indirect costs were excluded because the hospitals could not provide the information. Two hospitals reprocessed extracorporeal circuits and one did not, which makes comparison of preparation costs less straightforward. The costs are from 2014 and converted at a fixed exchange rate, so they may not match current prices. The study used three hospitals selected for good nursing practices and adequate resources, so the costs may not apply to other settings. It reports costs of procedures, not clinical outcomes such as infection, hospitalization or survival.
The easy way to misread this
Do not read the lower cost of fistula procedures as proof that fistula access is clinically better for every patient. This study measured direct procedure costs only, not patient outcomes, and the paper did not test whether nurses should choose one access type over another.