Reducing time for vascular access salvage: initial results from a single institution's clinical practice improvement...

Area of Science:

• Nephrology
• Vascular Surgery
• Healthcare Management

Background:

• Thrombosis is a primary cause of arteriovenous fistula (AVF) and arteriovenous graft (AVG) failure.
• Current guidelines advocate for early AVF salvage within 24-48 hours.
• Previous institutional practice showed a median delay of 3 days for vascular access (VA) salvage.

Purpose of the Study:

• To implement and evaluate a clinical practice improvement program (CPIP) aimed at reducing delays in VA salvage.
• To assess the impact of the CPIP on the timeliness of VA salvage, patient outcomes, and healthcare costs.

Main Methods:

• A phased CPIP was implemented: pre-intervention, pre-intervention, and post-intervention.
• Root cause analysis identified factors contributing to VA salvage delays.
• Key interventions included a multidisciplinary communication platform, structured workflow, and compliance reminders.

Main Results:

• The early VA salvage rate increased from 6.1% pre-intervention to 81.0% post-intervention.
• Median length of stay decreased from 5.65 days to 2.92 days.
• Hospitalization costs per patient were reduced by SGD$3144 post-intervention.

Conclusions:

• Successful implementation of a CPIP significantly improved early VA salvage rates.
• The CPIP demonstrated enhanced patient outcomes and substantial cost savings.
• Stakeholder involvement and a structured protocol were crucial for the program's success.