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

被引：0

作者：

Chan, Kai Siang ^{[1
]}

Yong, Enhui ^{[2
]}

Zhang, Li ^{[1
]}

Neo, Shufen ^{[1
]}

Zhou, Xueping ^{[1
]}

Gray, Joana Marie Eugenio ^{[3
]}

Elah, Diomampo Katriz Abanto ^{[1
]}

Ong, Ee Ling ^{[4
]}

Pan, Ying ^{[1
]}

Hong, Qiantai ^{[1
]}

Mak, Malcolm Han Wen ^{[1
]}

Chong, Lester Rhan Chaen ^{[1
]}

Tan, Glenn Wei Leong ^{[1
]}

Punamiya, Sundeep ^{[3
]}

Lim, Gavin ^{[3
]}

Chan, Gabriel ^{[3
]}

Gummalla, Krishna ^{[3
]}

Quek, Lawrence Han Hwee ^{[3
]}

Uei, Pua ^{[3
]}

Tan, Bien Peng ^{[3
]}

Kwan, Justin ^{[3
]}

Yong, Enming ^{[1
]}

机构：

[1] Tan Tock Seng Hosp, Dept Gen Surg, Singapore, Singapore

[2] UCL, Inst Cardiovasc Sci, London, England

[3] Tan Tock Seng Hosp, Dept Diagnost Radiol, Vasc & Intervent Radiol, Singapore, Singapore

[4] Tan Tock Seng Hosp, Off Qual & Clin Governance, Singapore, Singapore

来源：

BMJ OPEN QUALITY | 2025年 / 14卷 / 01期

关键词：

Control charts/Run charts; Healthcare quality improvement; PDSA; Quality improvement; Surgery; HEMODIALYSIS;

D O I：

10.1136/bmjoq-2024-003138

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background One of the most common causes of arteriovenous fistula (AVF) and/or arteriovenous graft (AVG) failure is thrombosis. Guidelines recommend early AVF salvage within 24-48 hours. Our institution reported poor compliance with these recommendations, with a median of 3 days prior to vascular access (VA) salvage. We present our initial results following the implementation of a clinical practice improvement programme (CPIP) to reduce delay to VA salvage. Methods The CPIP was conducted in three phases: pre-CPIP (23 January to 30 April 2023), CPIP pre-intervention (22 May to 3 September 2023) and CPIP post-intervention (4 September 2023 to 7 January 2024). Root cause analysis was performed to identify factors resulting in VA salvage delay. Measures implemented included a platform for multidisciplinary communication on cases requiring VA salvage, implementation of a structured workflow and regular reminders to ensure compliance. Early salvage was defined as <48 hours from triage at the emergency department. Time from admission to VA salvage, length of stay, incidence of femoral catheter (FC) insertion and overall cost savings were collected. Results There were 82 patients (90.1%) who received VA salvage during the CPIP period. The median age was 67 years with a male predominance (64%). There were 45 patients (54.9%) who received early VA salvage during CPIP. The run chart showed a median early VA salvage rate of 6.1% for pre-intervention and 81.0% for post-intervention. The median length of stay pre-intervention and post-intervention was 5.65 days and 2.92 days, respectively. The incidence of FC insertion was 17.1% (n=6/35) during CPIP for thrombosed VA. Eight patients failed to obtain early VA salvage during the post-intervention period. Overall hospitalisation cost savings per patient were SGD$3144 lower post-intervention. Conclusion We report the successful implementation of our CPIP through the involvement of stakeholders and stepwise implementation of measures using a structured protocol.

引用

页数：8

共 2 条

[1] Molecular characterization of clinical isolates from vascular access infection: A single-institution study
Tseng, Yuan-Hsi
Wong, Min Yi
Huang, Tsung-Yu
Lin, Bor-Shyh
Tung, Chun-Wu
Huang, Yao-Kuang
MICROBIOLOGYOPEN, 2020, 9 (11):
[2] Vascular access results from the Dialysis Outcomes and Practice Patterns Study (DOPPS): Performance against Kidney Disease Outcomes Quality Initiative (K/DOQI) clinical practice guidelines
Rayner, HC
Besarab, A
Brown, WW
Disney, A
Saito, A
Pisoni, RL
AMERICAN JOURNAL OF KIDNEY DISEASES, 2004, 44 (05) : S22 - S26

← 1 →