A Clotted Graft Should Not Mean a Missed Treatment: A Communication Plan for a Partnership Between Interventional Radiology and Three Community Dialysis Clinics
Student Name
American College of Education
NUR5123: Relationships Through Communication
Module 4 Assignment
Instructor Name
July 27, 2027
The Partnership and the Problem
People receiving hemodialysis depend on a working vascular access, usually a fistula or graft in the arm. When an access narrows or clots, it often needs a procedure in interventional radiology, such as a fistulagram with angioplasty or a declotting procedure, before the patient can dialyze again. The composite hospital's interventional radiology department performs about 60 such procedures a month for patients from three independent community dialysis clinics within 20 miles.
The communication between them is informal and fragile. Clinics send requests by fax, sometimes with a phone call and sometimes without. Faxes sent after 1500 on Fridays are often not seen until Monday. The interventional radiology department does not learn which requests are urgent, and clinics are not told when a procedure is scheduled until the patient calls them. In the past quarter, 14 patients missed at least one dialysis session while waiting for an access procedure, and 5 of them had a temporary dialysis catheter placed that might have been avoided. Missed treatments carry real harm: in an analysis of 44 million hemodialysis treatments, the two days after a missed session carried about four times the odds of hospitalization and twice the odds of an emergency visit compared with days after a completed session (Chan et al., 2014). The current national guideline on vascular access calls for timely treatment of access dysfunction and for care planned around each patient's long-term access needs (Lok et al., 2020). The partners have agreed to build a formal communication plan.
Principles for the Partnership
The partners are not in a hierarchy. The dialysis clinics are separate organizations with their own nephrologists and nurse managers, and they can send patients to other hospitals. Jones and Wells (2007), describing partnerships between academic institutions and community organizations, emphasize respect for each partner's knowledge, shared leadership and two-way exchange rather than one partner informing the other. The same principles apply here. The clinics know their patients, their schedules and their transport problems; interventional radiology knows its capacity and what makes a procedure safe. The plan is therefore written jointly by the interventional radiology nurse manager and the three clinic nurse managers, and it is co-chaired by one person from each side.
A partnership plan written by the hospital and sent to the clinics would be a notice, not a partnership, and it would be ignored as quickly as the faxes are.
What Each Partner Needs to Know
The plan begins with information needs, not channels. The clinics need to know that a request has been received, when the procedure is scheduled, what the patient must do beforehand, when the patient can dialyze afterward and what was done and found. Interventional radiology needs to know how urgent the request is, when the patient last dialyzed and is next due, the access history, anticoagulant use and any transport or language needs. Patients need to know where and when to arrive, whether to eat, whether to bring someone and when their next dialysis will be. Nephrologists need the procedure findings and any recommendation about the access's long-term future.
Channels, Cadence and Messages
Routine requests will move from fax to a shared referral form in the hospital's secure referral portal, which clinics can already access. The form requires the urgency level, the last and next dialysis date and time and the access history, and it cannot be submitted without them. Interventional radiology will confirm receipt through the portal within two business hours and post the scheduled time within one business day.
Urgent requests, meaning a clotted access or one that cannot support dialysis, will use a dedicated phone line answered by an interventional radiology nurse from 0700 to 1900 on weekdays and by the on-call team at other times, followed by the portal form. The standard is that a patient with a clotted access is treated before the next scheduled dialysis session whenever possible, and the nurse taking the call will tell the clinic at once whether that standard can be met.
After each procedure, the interventional radiology nurse will send a brief structured summary through the portal: what was done, what was found, whether the access can be used and when, any complication and any recommendation for the nephrologist. The clinic nurse will confirm receipt. Patients will receive the same information in plain language on paper and verbally before they leave.
The partnership will meet monthly for 30 minutes by video to review the previous month's cases, especially any missed dialysis, and quarterly in person with the nephrologists and interventional radiologists to review data and adjust the plan. Key messages for launch are short and shared by both sides: requests now go through the portal; urgent requests go to the dedicated line; every request will be confirmed; every patient's clinic will receive a summary.
Feedback and Measures
The plan includes three feedback loops. Any missed dialysis session linked to an access problem will be reviewed jointly at the next monthly meeting, without blame, to find where communication failed. Each clinic nurse manager will be asked each quarter to rate the partnership's communication and name one thing to change. And patients will be asked two questions by the clinic nurse after their procedure: whether they knew what to do beforehand and whether they knew when they could dialyze again.
The partnership's main measure is how many patients miss a dialysis session while waiting for an access procedure, with a target of fewer than three a quarter. Alongside it, the partners will track temporary catheters placed because of access delay, the percentage of requests confirmed within two business hours; and the percentage of procedure summaries received by the clinic on the same day. The co-chairs will report these measures to the hospital's vice president of nursing and to each clinic's administrator every quarter.
Risks
The largest risk is that the portal becomes another fax: technically available and practically ignored. The dedicated phone line and the two-hour confirmation standard are designed to prevent that, and the monthly review will show whether they do. A second risk is that interventional radiology cannot always meet the next-session standard, especially on weekends. When it cannot, the plan requires the nurse to say so at the time of the call, so the clinic can arrange an alternative, rather than leaving the clinic to discover the delay when the patient misses treatment. Honesty about capacity is part of the communication plan, not a failure of it. A third risk is turnover: the plan depends on a handful of people who know each other, and a new clinic nurse manager may never have heard of it. Each clinic will therefore keep a one-page summary of the plan in its orientation materials, and the co-chairs will meet any new manager within a month of their start.
References
Chan, K. E., Thadhani, R. I., & Maddux, F. W. (2014). Adherence barriers to chronic dialysis in the United States. Journal of the American Society of Nephrology, 25(11), 2642-2648. https://doi.org/10.1681/ASN.2013111160
Jones, L., & Wells, K. (2007). Strategies for academic and clinician engagement in community-participatory partnered research. JAMA, 297(4), 407-410. https://doi.org/10.1001/jama.297.4.407
Lok, C. E., Huber, T. S., Lee, T., Shenoy, S., Yevzlin, A. S., Abreo, K., Allon, M., Asif, A., Astor, B. C., Glickman, M. H., Graham, J., Moist, L. M., Rajan, D. K., Roberts, C., Vachharajani, T. J., & Valentini, R. P. (2020). KDOQI clinical practice guideline for vascular access: 2019 update. American Journal of Kidney Diseases, 75(4, Suppl. 2), S1-S164. https://doi.org/10.1053/j.ajkd.2019.12.001
How this NUR 5123 Module 4 example is structured
NUR 5123 Module 4 in many sections builds a communication plan for a community or academic partnership; your classroom's instructions decide which partnership and the plan's format. This example describes the partnership and the problem it solves, grounds the plan in partnership principles, identifies each partner's information needs, designs channels and cadence for routine and urgent communication, drafts key messages, builds in feedback and names measures of success.
NUR5123 Module 4 questions, answered
What does NUR5123 Module 4 usually ask for?
NUR5123 Module 4 in many sections asks you to build a communication plan for a partnership with a community organization or an academic institution, covering partners, goals, audiences, channels, messages, cadence and measures. Your classroom's instructions decide the partnership and format.
How do I start a communication plan?
Start with each partner's information needs, not with channels. Once you know who needs to know what, and how quickly, you can choose channels, set response times and draft messages that serve those needs.
How do I measure whether a communication plan works?
Measure the outcome the partnership exists to protect, plus a few process measures such as response times and whether summaries arrive. Add a way for partners and patients to tell you what is not working.
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