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).
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).
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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.
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].
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