Operationalizing anemia management: organizing the program and coordinating the team

Data indicate that a significant percentage of dialysis patients do not achieve the hemoglobin (Hb) target range of 11 to 12 g/dL. Our dialysis facility undertook a quality improvement program to assess and modify the processes affecting anemia-related outcomes. A 30% reduction in the percentage of patients with Hb levels below 11 g/dL was achieved by: (a) empowering an anemia manager to coordinate the team quality improvement effort, (b) integrating the Epotein alfa and iron protocols, (c) implementing a dose titration model for patients with Hb levels in the upper end of the target range, and (d) devising a "rapid ramping" protocol to ensure timely achievement of target Hb levels in patients who were new to dialysis or returning to the facility after hospitalization.