Vascular access getting better in the FHA renal program

The lastest vascular access data provided by BCPRA is out and things look promising for our program.

VA incidence
FHA Renal is  now one of the top 3 centres in the province.
Between April 2010 and Sep 2012, our incidence rate of AVF/AVG has increased from 24% to 36%.
During the same interval, the provincial mean is flat (31% to 32%).
VA Prevalence
Between April 2010 and Sep 2012, our prevalence rate of AVF/AVG has increased from 48% to 58%.  However, we’ve seen little improvement over the past year and are still far below top performing centres that are achieving 72% prevalence.  We do have much higher rates of AVF/AVG + CVC than most centres, suggesting we’re on the cusp of seeing our efforts comes to fruition as we get patients transitioned from CVC to AVF/AVG.
I think we have some momentum here but need to keep pushing.
a) In KCC
  • keep pushing our strategy of earlier modality decision making with referral at GFR 20 for patients choosing facility HD or HHD.
c) In the HD units
  • continue our VA review weeks to identify patients at risk of access failure or who could transition from CVC to AVF/AVG
  • continue to have all bedside RNs and MDs share the message of the value of an AVF over CVC
  • continue to work with IR to ensure we have rapid access to VA maintenance & salvage
  • bring in the transition nurses to ensure all new starts have optimized care pathways, including AVF referral for patients choosing facility HD or HHD
b) In PD
  • Earlier referral for AVF in patients who are showing signs of UF failure
  • Continue to support urgent start PD to ensure patients who are facing a suboptimal HD start with a CVC have a safer option
c) In Transplant
  • Earlier referral for AVF with progressive transplant failure who choose facility HD or HHD after modality education
d) In the Nephrologist offices
  • Continue to recommend permanent access creation for patients not choosing conservative care, pre-emptive transplant or PD, and communicate this messaging to the primary care providers in order to secure their support
e) In the ORs
  • Continue to explore innovative ways to get patients quicker access creation
Thanks for everyone’s hard work on this initiative.  It’s incredibly encouraging to see things move in the right direction,

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