A vascular access coordinator improves the prevalent fistula rate

Area of Science:

• Nephrology
• Vascular Access Management
• Healthcare Quality Improvement

Background:

• The Centers for Medicare and Medicaid Services established a 66% prevalent arteriovenous fistula (AVF) rate as a national standard.
• Optimizing vascular access is crucial for hemodialysis patients, impacting morbidity and mortality.
• Previous strategies had not met the national AVF benchmark in this practice.

Purpose of the Study:

• To evaluate the impact of a clinical vascular access coordinator (VAC) on increasing the AVF rate.
• To assess the effect of a multidisciplinary vascular access improvement program on access modality utilization.
• To determine if a VAC could help achieve the national AVF standard.

Main Methods:

• Implementation of an aggressive, multidisciplinary vascular access improvement program led by a nurse VAC.
• Establishment of physician-approved protocols for vascular access care starting in early 2009.
• Retrospective review of Network vascular access data from January 2008 to December 2010.

Main Results:

• The prevalent AVF rate increased from 50% to 65% following program implementation.
• The use of arteriovenous grafts decreased during the study period.
• The percentage of dialysis catheters used for over 90 days was reduced by 50%.

Conclusions:

• A dedicated VAC, implementing a multidisciplinary program, can significantly improve AVF rates.
• This approach effectively reduces reliance on grafts and long-term catheter use.
• The VAC model shows promise for helping practices meet national vascular access quality standards.