Reducing time to arteriovenous access creation in incident end stage kidney disease: A single-centre quality...

Timely arteriovenous (AV) access creation to reduce catheter burden in patients with End-Stage Kidney Disease (ESKD) is essential, but delays remain common. We implemented a Clinical Practice Improvement Programme (CPIP) to reduce delays to AV access creation in patients with incident ESKD, who initiated haemodialysis via tunnelled dialysis catheters and underwent first-time AV access creation.

We conducted a quality improvement study in a single-centre, tertiary institution in Singapore. Interventions implemented used root cause analysis and Plan-Do-Study-Act cycles to streamline workflows, desynchronised the need for vessel mapping prior to surgical consultation, and introduced a prioritised inpatient referral pathway. Primary outcome was time from nephrology referral to surgical AV access creation. Secondary outcomes included time intervals between referral, vessel mapping, surgical listing and surgery.

A total of 227 patients were included (75 pre-CPIP, 152 post-CPIP). Following CPIP implementation, the median time from referral to AV access creation decreased from 142 days pre-intervention to 105 days at 6 months and 86 days at 12 months post-intervention (p < 0.001), representing a reduction of 40.9%. The median time from vessel mapping to surgical listing was significantly reduced from 41 days pre-CPIP to 11 and 9 days at 6 and 12 months post-CPIP, respectively (p = 0.002). Time from surgical evaluation and listing to surgery remained unchanged.

The CPIP significantly reduced delays from nephrology referral to surgical AV access creation. Earlier surgical evaluation and streamlined workflows may improve time to fistula use and reduce catheter-related complications.