TMUH provides integrated care and screening for high-risk dialysis patients (with CAD, PAOD, or hypotension), effectively preventing complications and lowering mortality to ensure dialysis safety.

This year, we continued to advance multidisciplinary team care. Due to the aging dialysis population and multiple comorbidities, patients often suffer from concurrent cardiovascular diseases and infections, leading to hospitalization and mortality. Through cross-disciplinary collaboration and enhanced screening, our team detects potential high-risk patients early and intervenes promptly to improve patient prognoses. Currently, our department utilizes a population medicine approach with a dual-axis framework (cardiovascular disease and infection) to reduce the mortality rate of dialysis patients。

Axis 1: Reducing Cardiovascular Complications in Dialysis Patients We proactively schedule regular echocardiograms and nuclear medicine Thallium-201 myocardial perfusion scans. All high-risk patients are referred to cardiology for interventional treatment and joint cross-disciplinary care.

Axis 2: Minimizing Infection Risks in Dialysis Patients We implement nasal Staphylococcus aureus screening and decolonization protocols while strictly enforcing infection control measures to reduce infection rates and promote patient safety.

We promote cross-disciplinary collaboration for high-risk patients and introduce proactive screening and decolonization strategies. Utilizing a population medicine approach with a dual-axis framework (cardiovascular disease and infection), we aim to reduce the mortality rate of dialysis patients.

Axis 1：Reducing Cardiovascular Complications in Dialysis Patients

1-1 Establish a joint care plan with the Cardiology Department.

1-2 Identify high-risk populations based on medical history and clinical symptoms.

1-3 Arrange relevant cardiac examinations.

1-4 Implement targeted interventions for abnormal cases.

1-5 Track and analyze cardiovascular-related mortality rates monthly.

Axis 2：Minimizing Infection Risks in Dialysis Patients 2-1 Establish a joint care plan with the Infectious Disease Department.

2-2 Conduct routine screenings on a quarterly basis.

2-3 Implement targeted interventions and protocols for positive cases.

2-4 Maintain continuous execution to minimize infection risks in dialysis patients.

2-5 Track and analyze bacteremia rates and infection-related mortality ratios quarterl

• Through the aforementioned interdisciplinary collaboration implemented since April 2020, referrals for cardiac examinations have significantly increased. This has enabled early detection of cardiovascular diseases and prompt referral to the cardiology team for timely treatment, reducing overall mortality risks and improving clinical prognoses. Specifically, dialysis patients with triple-highs, CAD, or PAOD, who experience chest pain, tightness, dyspnea, or intradialytic hypotension, are scheduled for echocardiography, nuclear medicine Thallium-201 myocardial perfusion scans, and peripheral vascular scans. Driven by population medicine, the number of screened patients has increased, achieving a 100% screening execution rate for high-risk patients. Given that the abnormal rate in previous high-risk screenings exceeded 90%, integrated cardio-renal care has been fully provided to all high-risk patients undergoing examinations since 2023 (see Figure 1 in supporting documents).

• For Staphylococcus aureus, the primary pathogen in hemodialysis patients, comprehensive routine active nasal screening and decolonization therapy were implemented. Since 2016, active nasal swab collection has been conducted quarterly, with a 100% execution rate. The nasal MRSA positivity rates were 15.7% (2023), 18.3% (2024), and 12.3% (first half of 2025), with a 100% decolonization treatment rate for positive cases.

According to the latest Taiwan Renal Registry Report published by the Taiwan Society of Nephrology, the national mortality rate was 12.0 per 100 person-years in 2019 and 11.7 per 100 person-years in 2020. Although patient demographics and the burden of comorbidities may vary compared to national data, the average pre-intervention mortality rate of dialysis patients in our hospital was 1.5% (1.5 per 100 person-years). Following the intervention, this rate improved to 1.18% (1.18 per 100 person-years), demonstrating a continuous year-over-year declining trend. Through the active interventions of our cardio-renal team, the cardiovascular mortality rate of our dialysis patients has been significantly improved.

• The quality and safety mechanisms for the two main axes are achieved through the following strategies and actions

• Axis 1:

• Case managers accurately screen high-risk patients and refer them for examinations on a monthly basis. 2.Report the execution rate at the monthly department meeting.

• Report the mortality rate at the monthly department meeting.

• Conduct patient satisfaction surveys.

• Axis 2:

• Professionally trained, designated sampling team members perform quarterly specimen collection, monitoring, decolonization, re-testing, and follow-ups to ensure effective control of specimen quality.

• Monitor infection rates quarterly and benchmark them against the hospital-wide infection rates.

• In addition to strictly monitoring execution rates and patient prognoses, patient satisfaction is regularly reviewed. In the 2024 satisfaction survey, the Hemodialysis Center scored 87.8 points, the Inpatient Nephrology Department scored 96.8 points, and the Outpatient Nephrology Department scored 88.3 points.

Monitor infection rates quarterly and benchmark them against the hospital-wide infection rates. In addition to strictly monitoring execution rates and patient prognoses, patient satisfaction is regularly reviewed. In the 2024 satisfaction survey, the Hemodialysis Center scored 87.8 points, the Inpatient Nephrology Department scored 96.8 points, and the Outpatient Nephrology Department scored 88.3 points.

• Publication：Published in Critical Care (2015).

• Award: Awarded the Silver Award in the 2017 Taiwan Healthcare Quality Quality Contest for the project titled "The Effectiveness of Active Screening on Staphylococcus aureus Infection in the Hemodialysis Unit."

• Cardiovascular preventive interventions effectively reduce sudden cardiac death, lower the incidence of acute myocardial infarction, and slow the progression of heart failure deterioration.

• The reduction in non-cardiovascular mortality exceeded that of cardiovascular mortality. This is potentially driven by the impact of infection prevention interventions, which demonstrated even greater efficacy than the cardiovascular preventive measures.