title: Patients who try our patience.
abstract: The outpatient dialysis industry is experiencing a dramatic growth in new patients. A shortage of professional nephrology staff, coupled with increasing frustration with the system on the part of a number of dialysis patients, contributes to an environment of frustration and negative behaviors. The dialysis industry lacks concise or practical definitions to describe these behaviors and respond with appropriate interventions. Patients may be labeled improperly and then discharged inappropriately and involuntarily. The TransPacific Renal Network, a nonprofit agency supported with funds from the Centers for Medicare and Medicaid Services, convened a volunteer multidisciplinary work group to address this issue. The group's tasks were to develop behavioral definitions specific to dialysis therapy that could be understood easily by any dialysis staff member, classify these definitions into at-risk categories, examine the parameters of a zero-tolerance policy, and provide objective pathways to guide staff interventions.
authors.affiliation: TransPacific Renal Network, San Rafael, CA, USA. asukolsky@nw17.esrd.net
authors.forename: Arlene
authors.initials: A
authors.lastname: Sukolsky
mesh_terms: D000488:Allied Health Personnel / Q000523:psychology*; D000554:Ambulatory Care Facilities / Q000639:trends; D019955:Conduct Disorder / Q000523:psychology; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000628:therapy; D008297:Male; D009723:Nurse-Patient Relations; D010045:Outpatients / Q000523:psychology*; D010351:Patient Discharge; D006435:Renal Dialysis / Q000639:trends*; D016312:Treatment Refusal; D000078329:Workforce