Redefining Kidney Care: A Health System's Transitional Journey from Outsourced to In-House Hemodialysis Services.

The pilot transition from outsourced to in-house hemodialy sis (HD) services at a 274-bed acute care hospital resulted in significant cost savings, operational improvements, and enhanced patient care. By adopting an advanced in-house HD model, the pilot hospital reduced per-treatment costs by 89.2%, eliminated outsourced vendor-imposed penalties, and achieved a 0% turnover rate among nephrology nurses. A structured, multidisciplinary strategy streamlined workflows and improved staff engagement. The pilot's success catalyzed system-wide expansion over four years across eight hospitals, demonstrating financial sustainability, scalability, and clinical benefits of an in-house HD model.