Renal Ventures Team Linked Care (RV TLC) started in 2014 to enable dialysis clinics to work closer with hospitals and facilitate the improved care of Renal Ventures patients post-hospitalization. If patients become hospitalized, once discharged they are at a high risk to be hospitalized again unless clinic staff follows up with the patient and stops this cycle.
Through the RV TLC program, RVM facilities communicate with a patient and the hospital after discharge. Staff work closely with the patient for at least 30 days after he or she comes in for the first dialysis treatment after being discharged from the hospital.
The program helps patients with follow up appointments, medication lists, and community resources. This form of "intense care" can continue for a month or longer to help the patient transition back to dialysis and stay out of the hospital.
In its first year, the program showed great promise by decreasing rehospitalizations by 40%. In addition, 78% of patients received a permanent access before they were discharged from the hospital. Changing from a catheter to an access helps dialysis patients decrease infection and the risk of being rehospitalized.
As the RV TLC program is constantly evaluated and improved, an additional feature has been added. Clinics have started providing nutritional supplements after each treatment because hospitalizations can result in a poor nutritional status and thereby continue the cycle of hospitalization.