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尽量减少对血液透析准入成熟的延迟:质量改进分析
Andrew S Warren1,2, Hannah Wolf1, Charles J Hillenbrand1
1Division of Vascular Surgery, University of Washington, Seattle, WA, USA.
The journal of vascular access
|April 11, 2024
概括
血液透析 (HD) 准入创建的手术前静脉映射造成了显著的延迟,特别是在门诊患者中. 然而,映射时间与导管使用的增加没有相关性,这表明了减少等待时间的替代策略.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 血管外科 血管外科
- 医疗保健服务研究 医疗服务研究
背景情况:
- 优化手术前过程可以降低医疗保健成本,加快血液透析 (HD) 的干预时间.
- 术前的船只绘图是我们在HD访问创建实践中的必需步骤.
- 我们假设血管映射导致最长的延迟,并与增加的导管天数相关.
研究的目的:
- 为了评估血液透析 (HD) 的术前延迟.
- 为了确定预操作船只绘图对干预时间的影响.
- 评估与映射相关的延迟和导管使用时间之间的相关性.
主要方法:
- 130名接受初始HD访问创建的患者的回顾性审查 (01/01/2017-12/31/2021).
- 使用曼-惠特尼U测试的住院患者和门诊患者之间的术前事件时间的比较.
- 通过基于导管的HD发病时间和回归分析来对门诊患者进行分层分层,以映射延迟影响.
主要成果:
- 与门诊患者相比,住院患者经历了较短的转诊到访问成熟时间,这是由于转诊到映射和映射到手术前评估时间的缩短.
- 术前评估到手术室 (OR) 时间代表了两个组最长的术前延迟.
- 在门诊患者中,道导管安置后转诊增加了接入成熟时间,但没有术前延迟;绘制时间和导管持续时间之间没有发现相关性.
结论:
- 术前静脉测绘显著促进了转诊到成熟的时间,但与道导管持续时间的增加无关.
- 道导管放置影响了接入成熟,但没有增加手术前的延迟.
- 较早的转诊,减少门诊等待时间 (转诊到手术室),以及增加动脉静脉移植的放置可能会减轻与手术前静脉测绘相关的延迟.
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