A journey in reversing practice patterns: a multidisciplinary experience in implementing DOQI guidelines for vascular access

A, Ackad; Simonian, Gregory; Steel, K S; Parisi, Christopher; Mancini, Sharon; Douglas, Claudia; Buckner, Darrell

doi:10.1093/ndt/gfh818

Cited by 33 publications

(25 citation statements)

References 15 publications

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“…In 2 separate studies conducted in Australia, the proportion of patients starting dialysis with a functional permanent access increased from 24 to 83% in one study implementing a multidisciplinary team intervention, and from 60 to 75% in a second study where a nurse access coordinator was implemented [9,10] . Conversely, in a US study, the proportion of incident dialysis patients with a permanent access in place within a year of dialysis initiation increased from 20 to 60% after the implementation of a multidisciplinary team intervention, but the percentage of patients starting dialysis with a functional permanent access decreased from 31 to 20% [12] . Similarly, in a large US health maintenance organization, which implemented a quality improvement program to improve access management, although the percentage of patients with a primary AVF increased from 38 to 88%, the percentage of patients starting dialysis with a functional permanent access decreased from 47 to 35%.…”

Section: Discussionmentioning

confidence: 88%

“…Two separate studies from Australia found that a multidisciplinary team intervention and an access coordinator, respectively, increased the proportion of patients starting dialysis with a functional permanent access [9,10] . Conversely, 2 studies from the United States reported that a multidisciplinary team intervention increased the placement of arteriovenous fistulas (AVFs) but did not reduce temporary catheter use at the start of dialysis [11,12] . Previous studies have focused on patients who were receiving regular nephrology care prior to end-stage renal disease (ESRD).…”

Section: Introductionmentioning

confidence: 99%

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Effect of a Dialysis Access Coordinator on Preemptive Access Placement among Veterans: A Quality Improvement Initiative

et al. 2016

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Background and Objectives: Preemptive placement of permanent dialysis access is recommended in order to reduce the morbidity associated with central venous catheters. We assessed the effect of a dialysis access coordinator on preemptive access placement in veterans who are at high risk for end-stage renal disease (ESRD). Design, Setting, Participants, and Measurements: Pre-post evaluation of a dialysis access coordinator in the nephrology clinics of the Veterans Affairs Palo Alto. The access coordinator streamlined access referrals, prioritized surgical waiting lists and addressed patient barriers. We compared the frequency of preemptive access referral, surgery, and use for dialysis during the intervention period, July 1, 2013 to May 31, 2016, to a pre-intervention period, January 1, 2011 to December 31, 2013, among all patients with a predicted 1-year risk for ESRD ≥20%. Results: There were 156 patients in the historical cohort and 131 in the intervention cohort. The mean age was 69.9 ± 11.6 years and the mean estimated glomerular filtration rate was 14.5 ± 5.7 ml/min/1.73 m². The intervention was associated with an 11.8% increase in access referral (p value = 0.03), and a 9.4% increase in completed access surgery (p value = 0.05). Increases in permanent access at the start of dialysis (15.2%), and functional permanent access at the start of dialysis (12.4%) did not reach statistical significance. Among patients who received access surgery, there was no significant difference in the prevalence of unused access. Conclusions: Implementation of an access coordinator was associated with a modest increase in preemptive access placement among patients who are at high risk for ESRD without increasing the prevalence of unused access.

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Section: Discussionmentioning

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Effect of a Dialysis Access Coordinator on Preemptive Access Placement among Veterans: A Quality Improvement Initiative

et al. 2016

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“…These centre-specific results outnumber other single centre achievements [9,10]. Two centres that already had high AVF baseline levels managed to increase the use even more.…”

Section: Range and Demographicsmentioning

confidence: 85%

“…Since the appearance of the first Dialysis Outcomes Quality Initiative (DOQI) guidelines in 1997, several reports have shown that dramatic changes in access placement can be achieved in a short period of time [9][10][11][12][13]. However, those studies were performed in centres that were characterized by low fistula incidence and prevalence levels at baseline.…”

Section: Change In Timementioning

confidence: 99%

Accelerated increase of arteriovenous fistula use in haemodialysis centres: results of the multicentre CIMINO initiative

Huijbregts

Bots

Moll

2007

Nephrology Dialysis Transplantation

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Background. In the Netherlands, arteriovenous fistulas (AVFs) are used in 60-65% of the haemodialysis patients and this compares poorly with the European average. A multicentre guidelines implementation programme, CIMINO, was initiated aiming at increasing the use of AVFs. Methods. Physicians and dialysis staff in 11 participating centres (N ¼ 1092 vascular accesses) were strongly and repeatedly advised to adhere to current guidelines with extra attention for pre-operative duplex examination and salvaging of failing and failed fistulae. Specially appointed access nurses prospectively registered all created vascular accesses using an internetlinked database. In 22 other centres (N ¼ 1566 accesses), the CIMINO programme was not offered and they were considered the control group. Results. On 1 January 2006, average follow-up time of the CIMINO group and the control group were 13.3 months and 34.1 months, respectively. A total of 598 new vascular accesses (77% AVFs) were created in the CIMINO group. Prevalent AVF use increased from 58.5% (range: 31-79%) to 62.7% (range: 45-83%) in the CIMINO group and from 65.5% (range: 31-91%) to 67.3% (range: 42-91%) in the control group. The increase in AVF use per year was significantly quicker than in the control group (P < 0.05). Use of untunnelled catheters decreased whereas that of tunnelled catheters increased. Conclusions. This initiative shows that a multicentre guidelines implementation programme results in an accelerated increase of AVF use in comparison with a time control group. These data suggest that the choice of access placement depends predominantly on centrespecific factors.

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“…The percentage of patients using a central venous catheter as their first hemodialysis access and thereafter as a prevalent vascular access has grown steadily since 1998 [1, 2]. …”

Section: Introductionmentioning

confidence: 99%

Catheter-Related Bacteremia in Hemodialysis: Which Preventive Measures to Take?

Silva¹,

Costa²,

Baptista³

et al. 2008

Nephron Clin Pract

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Background: The use of tunneled hemodialysis catheters as definitive vascular access is becoming increasingly more widespread, reaching 25% of all dialysis patients in some countries. The rate of infectious morbidity and mortality is much higher when catheters are used than when patients are dialyzed through grafts or native fistulas, and it is generally agreed that implementing appropriate preventive measures would do more to lower its incidence. Methods: A prospective, randomized, open-label, long-term follow-up clinical trial was conducted to compare the efficacy of dressing the exit site with antibiotic ointment (AO) versus catheter antimicrobial locking (AL) in preventing catheter-related bacteremia (CRB), both associated with strict standard precautions and appropriate catheter care. A total of 141 tunneled catheters, newly implanted in 116 consecutive patients, were followed during a 2-year period. Patients were randomly distributed into one of three arms, with group A receiving AO prophylaxis, group B treated with a heparin + gentamicin (5.2 mg/ml) lock (AL) and group C receiving both AO and AL prophylaxis. Results: Group A had a significantly lower infection-free time survival curve (p < 0.02, Kaplan-Meier) with a catheter survival of 103.9 days and a significantly higher number of CRB (9 episodes, p < 0.02, χ²). Group B had 130.7 mean infection-free days and 1 episode of CRB. Group C had 127.3 mean infection-free days and 5 episodes of CRB. No toxicity or other adverse events were observed during this 2-year period, and the efficacy of the preventive measures remained stable throughout. Conclusion: Antimicrobial lock is superior to AO as a CRB preventive measure. The use of lock and ointment in the same catheter was not associated with additive effects.

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A journey in reversing practice patterns: a multidisciplinary experience in implementing DOQI guidelines for vascular access

Abstract: A reversal in practice pattern from graft to fistulae creation was achieved by the successful implementation of DOQI guidelines. This also resulted in a reduction in morbidity.

Cited by 33 publications

References 15 publications

Effect of a Dialysis Access Coordinator on Preemptive Access Placement among Veterans: A Quality Improvement Initiative

Effect of a Dialysis Access Coordinator on Preemptive Access Placement among Veterans: A Quality Improvement Initiative

Accelerated increase of arteriovenous fistula use in haemodialysis centres: results of the multicentre CIMINO initiative

Catheter-Related Bacteremia in Hemodialysis: Which Preventive Measures to Take?

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