title: An investigation of satellite hemodialysis fallbacks in the province of Ontario.
abstract: OBJECTIVE
  In Ontario, Canada, hemodialysis services are organized in a "hub and spoke" model comprised of regional centers (hubs), satellites, and independent health facilities (IHFs; spokes). Rarely is a nephrologist on site when dialysis treatments take place at satellite units or IHFs. Situations occur that require transfer of the patient back ("fallbacks") to the regional center that necessitate either in- or outpatient care. Growth in the satellite dialysis population has led to an increased burden on the regional centers. This study was carried out to determine the incidence, nature, and outcome of such fallbacks to aid resource planning.
  
  
  METHODS
  Data were collected on 565 patients from five regional centers over 1 yr. These regional centers controlled 19 satellite dialysis centers including 7 IHFs.
  
  
  RESULTS
  There were 681 fallbacks in 328 patients: 1.21 incidents per patient or 2.1 incidents per patient year. Multiple fallbacks occurred in 170 patients. Fallback episodes lasted a mean of 10.3 d, requiring 4.6 dialysis treatments. Forty-five percent of fallbacks required hospitalization with a mean stay of 16.7 d. Access-related problems (33%) and nondialysis medical causes (32%) were the major causes of fallback. Resolution of the problem occurred in 87.8%, with the patient returning to the satellite. By the end of the study 77.3% were still satellite patients, 10.8% died, 3.8% returned to the regional center, 3.4% were transplanted, and 4.7% were transferred to other treatment modalities.
  
  
  CONCLUSIONS
  Fallbacks are common, yet the model operates well.
authors.affiliation: The University of Western Ontario and London Health Sciences Centre, London, Ontario, Canada. Robert.lindsay@lhsc.on.ca
authors.forename: Robert M
authors.initials: RM
authors.lastname: Lindsay
authors.forename: Janet
authors.initials: J
authors.lastname: Hux
authors.forename: David
authors.initials: D
authors.lastname: Holland
authors.forename: Steven
authors.initials: S
authors.lastname: Nadler
authors.forename: Robert
authors.initials: R
authors.lastname: Richardson
authors.forename: Charmaine
authors.initials: C
authors.lastname: Lok
authors.forename: Louise
authors.initials: L
authors.lastname: Moist
authors.forename: David
authors.initials: D
authors.lastname: Churchill
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003151:Community Health Centers / Q000458:organization & administration*; D003695:Delivery of Health Care / Q000458:organization & administration*; D005260:Female; D006760:Hospitalization; D006781:Hospitals, Satellite / Q000458:organization & administration*; D006801:Humans; D016030:Kidney Transplantation; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000458:organization & administration; D009398:Nephrology / Q000458:organization & administration*; D009864:Ontario / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D010360:Patient Transfer / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration; D012040:Regional Health Planning / Q000458:organization & administration*; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult