Ensuring “compassion” is at the core of compassionate dialysis screening

End-stage renal disease, or ESRD, is a serious medical condition caused by failure of the kidneys that also has significant social and economic implications. The only treatments for end-stage renal disease are regular courses of dialysis or a kidney transplant.

For individuals with ESRD who do not have access to treatment, either because they are uninsured or they may not be a legal residents of the U.S., often their only option is to resort to going to the emergency room in order to receive dialysis. However, mandatory hospital and even county protocols structured to prevent emergency room congestion can result in an individual seeking dialysis treatment being sent home if their medical status is not deemed life-threatening at that time.

Unfortunately, these policies for the most part are ineffective at preventing ER congestion and also have the potential to negatively impact these patients’ health by delaying treatment.

So is there a way to strike a balance between alleviating already strained emergency room resources while still providing life-saving care to vulnerable patients with very limited options?

Joining me to discuss their research on this very topic are Sila Çetinkaya with Southern Methodist University and Olga Bountali with the University of Toronto.

The key point here is that there is really no other real option for this group of patients and this is what makes the situation sad. And at the end of the day, the existence of this protocol and this compassionate dialysis mechanism implies inconsistent treatment. So the impact of inconsistent treatment when we have to do with a chronic disease is very significant as you probably can imagine, because it leads to deterioration, progressive deterioration. So the impact is huge.

Interviewed this episode:

Sila Çetinkaya

Southern Methodist University

Sila Çetinkaya is Department Chairperson and Professor of OREM and Cecil H. Green Professor of Engineering in the SMU Lyle School of Engineering. She holds courtesy appointments with ITOM in the SMU Cox School of Business and with Internal Medicine in the UT Southwestern Medical Center. Çetinkaya’s research interests include supply chain and healthcare analytics, stochastic optimal control theory, and applied probability. Her publications appeared in the most reputable outlets of industrial engineering and management science including Operations Research, Management Science, Production and Operations Management, IISE Transactions, Informs Journal of Applied Analytics (previously, Interfaces), and Naval Research Logistics, among many others. Her research program has been funded by multiple grants from National Science Foundation (NSF), Department of Education, Texas Engineering Education Coordination Board, and industry. She is a department editor of IISE Transactions and an associate editor of Naval Research Logistics. Çetinkaya’s early career accomplishments were recognized by NSF CAREER Award in 2001 and IISE Outstanding Young Industrial Engineer Award in 2003. She was named IISE Fellow in 2012 for outstanding lifetime contributions to industrial engineering.

Olga Bountali

University of Toronto

Olga Bountali is an Assistant Professor of Operations Management at the University of Toronto. She is cross-appointed in the Institute of Communication, Culture, Information and Technology and the Department of Management at University of Toronto Mississagua, and the Rotman School of Management. She holds a Ph.D. from the Operations Research Group of the Department of Mathematics, at the University of Athens. Prior to joining the University of Toronto, Olga was a postdoctoral fellow at Southern Methodist University (OREM Department) and Koç University (Industrial Engineering Department).

Her research interests are in operations management with a focus on stochastic modeling and complex decision-making under competition. In particular, her expertise lies in applying economic analysis to quantify how the behavior of self-interested customers impacts service operations, revenues, and the delivery of health care. She has active collaborations with people from diverse disciplines, including physicians and practitioners at Parkland Memorial Hospital and UT Southwestern in the DFW Metroplex. Olga is also a research fellow at the Sandra Rotman Centre for Health Sector Strategy.