NDT Advance Access published online on April 26, 2005
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfh818
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1 Division of Nephrology - Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
* To whom correspondence should be addressed. Background. The National Kidney Foundation has established detailed guidelines due to increasing morbidity and costs related to haemodialysis vascular access in the end-stage renal disease population. Methods. A quality assurance multidisciplinary committee was formed to implement the Dialysis Outcome Quality Initiative (DOQI) guidelines in September, 1999. Beginning January 2000, a ‘Save the Vein Programme’ was implemented and native fistulae became the angioaccess of first choice for new patients. In addition, an effort was made to replace failed non-autogenous vascular accesses with autogenous fistulae. Shortly after, pre-operative evaluation of the vascular anatomy of the arm by Doppler ultrasound became the standard of care. The 1 year period prior to January 2000 was used for comparison. Results. Total fistula creation in the year 1999 was 48. In the first year after the Save the Vein Programme was begun, 77 new fistulae were created and 96 fistulae in the following year. Concurrently, 50 grafts were constructed in 1999; this number decreased to 46 in 2000 and to 15 in 2001. The percentage of functional fistulae in incident patients increased from 20 to 60% (P<0.001). Similarly, in prevalent patients, functional fistulae increased from 24 to 44% (P<0.004). For all patients, there was a reduction in the hospitalization rate from 98 to 79% (P<0.001) and of vascular-related admissions from 67 to 53%. Conclusion. 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.
Received November 15, 2004
Accepted March 10, 2005
Original Articles
A journey in reversing practice patterns: a multidisciplinary experience in implementing DOQI guidelines for vascular access
2 Division of Endovascular Surgery - Department of Surgery, Hackensack University Medical Center, Hackensack, NJ, USA
3 Division of Geriatrics - Department of Internal Medicine, Hackensack University Medical Center, Hackensack, NJ, USA
4 Division of Nephrology, Hackensack University Medical Center, Hackensack, NJ, USA
5 Department of Nursing, Hackensack University Medical Center, Hackensack, NJ, USA
6 Department of Research, Hackensack University Medical Center, Hackensack, NJ, USA
7 Department of Performance Improvement, Hackensack University Medical Center, Hackensack, NJ, USA
Alexandre Ackad, E-mail: aackad{at}humed.com
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