Management of vascular access in a haemodialysis clinic

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We sought to evaluate the change in admission and procedural outcomes before and after the establishment of a vascular surgeon-led comprehensive renal vascular access clinic (RVAC)” Thomas et al (2016).

Abstract:

BACKGROUND: Management of vascular access for haemodialysis is a leading cause of morbidity and hospitalization in patients with end-stage renal disease. We sought to evaluate the change in admission and procedural outcomes before and after the establishment of a vascular surgeon-led comprehensive renal vascular access clinic (RVAC).

METHOD: A retrospective clinical study was conducted after an RVAC was established in January 2013, with retrospective database created for the 24-month period prior to and after.

RESULTS: The number of inpatient encounters for haemodialysis vascular access care fell over identical time periods before (n = 193) and after (n = 164) the RVAC was established. This reduction was associated with a significant decrease in length of stay (from 10.71 to 3.14 days; P = 0.0056) and thrombosed access procedures (from 32 to 16; P = 0.048). The proportion of emergency procedures fell (from 54.5 to 25.4%; P = 0.002) with a trend towards less arteriovenous fistula formations in the latter group (from 75 to 49; P = 0.099). There was also a trend towards fewer procedures in the latter group (from 195 to 151; P = 0.22). A case-mix costing analysis showed an estimated reduction in mean admission cost from $25 883.15 to $9332.81 for those 2-year periods, equating to a saving of $3.46 million associated with the introduction of the clinic.

CONCLUSION: The establishment of an RVAC has led to a variety of objective performance outcome improvements, including a decrease in hospital admission, length of stay, revision and emergency surgeries, with associated cost saving. It reflects positive outcomes observed in other surgical specialties’ clinics.

Reference:

Thomas, S.D., Ip, E.C., Katib, N., Pugh, D., Lennox, A., Endre, Z., Tan, E., Ellery, C. and Varcoe, R.L. (2016) A comprehensive renal vascular access clinic results in improved patient outcomes and reduced costs. ANZ Journal of Surgery. October 9th. [Epub ahead of print].

doi: 10.1111/ans.13794.

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