Multidisciplinary Approach to Reduce Catheter Use in Hemodialysis Centers

Background: Use of hemodiaysis catheters is associated with decreased survival and infections. 80% of new hemodialysis patients initiate hemodialysis with a catheter. CMS-QIP program and EQRS monitor catheter use rates and significant deviations from national averages are associated with economical penalties to dialysis providers. We aimed at increasing the proportion of patients initiating hemodialysis with a permanent access in place and accelerate the transition to successful cannulation of an AV fistula or AV graft Methods: Teams involved in the care of patients with advanced kidney disease (nephrology, vascular surgery, hospital medicine, vascular access coordinators, nephrology outpatient nurses, and business specialists) met during several days to delineate plans to accelerate the creation of a AV vascular access on patients admitted to Emory University Hospital Midtown. If patients were considered candidates to initiate dialysis, an immediate consultation with surgery was obtained and surgery was performed during same admission. If surgery could not be performed due to intercurrent illness or scheduling conflicts, a date for surgery was set before discharge Results: During the observation period (1/25-4/25), 49 new patients have been admitted to Emory hemodialysis centers. 45% of new hemodialysis patients initiated dialysis with permanent access already in place (9 with grafts, 11 fistulas, 2 peritoneal dialysis catheters). The time to successful cannulation with 16-gauge needles has decreased from 103 days during 2024 to 39 days during the observation period. Figure displays the probability of successful use of an AV access at 90 days Conclusion: A project designed to increase the number of patients with an access in place by the time they initiate outpatient hemodialysis has resulted in a significant reduction of cannulation time. If this initiative is sustained over time, it should result in a reduction in catheter use prevalence in our dilaysi centers. This approach may prove particularly relevant in areas where most of new dialysis patients are initiated during hospitalization