What is your approach for arranging outpatient antibiotics on discharge for a hospitalized patient with ESKD who receives in-center hemodialysis at a unit you do not round at?

Ideally, the best option would be to call both the dialysis unit and the outpatient nephrologist. Understandingly, this may be time-consuming. If I were to choose between the two, I would call the outpatient nephrologist since they may have a reason to change the plan to some degree; however, one risks the antibiotics not being given at all.

In the US, antibiotic orders administered in a dialysis facility must come from a clinician who is credentialed at that unit, typically the outpatient nephrologist or the medical director, if the outpatient nephrologist is unavailable. One cannot place orders directly to a unit where he/she has no privileges.

Regarding payment, under the ESRD PPS, the bundled rate covers drugs and services related to maintenance dialysis. IV antibiotics for non-ESRD-related infections are generally not included...