Reducing time to arteriovenous access creation in incident end stage kidney disease: A single-centre quality improvement study

BACKGROUND: Timely arteriovenous (AV) access creation to reduce catheter burden in patients with End-Stage Kidney Disease (ESKD) is essential, but delays remain common. We implemented a Clinical Practice Improvement Programme (CPIP) to reduce delays to AV access creation in patients with incident ESKD, who initiated haemodialysis via tunnelled dialysis catheters and underwent first-time AV access creation. METHODS: We conducted a quality improvement study in a single-centre, tertiary institution in Singapore. Interventions implemented used root cause analysis and Plan-Do-Study-Act cycles to streamline workflows, desynchronised the need for vessel mapping prior to surgical consultation, and introduced a prioritised inpatient referral pathway. Primary outcome was time from nephrology referral to surgical AV access creation. Secondary outcomes included time intervals between referral, vessel mapping, surgical listing and surgery. RESULTS: = 0.002). Time from surgical evaluation and listing to surgery remained unchanged. CONCLUSIONS: The CPIP significantly reduced delays from nephrology referral to surgical AV access creation. Earlier surgical evaluation and streamlined workflows may improve time to fistula use and reduce catheter-related complications.