Implementation of a multi-disciplinary hemodialysis access clinic improves time to surgical evaluation and access case volume

Background: Delays in hemodialysis access creation contribute to prolonged tunneled dialysis catheter dependence and morbidity. In March 2025, our institution implemented a multidisciplinary accelerated hemodialysis access clinic with weekly reserved appointments, same-day duplex vein mapping, and streamlined nephrology-to-surgery referral. We evaluated its effect on access volume, timing to surgical evaluation, and catheter dependence. Methods: We performed a retrospective chart review of adults undergoing hemodialysis access procedures at a tertiary academic center from March 17, 2024 to March 13, 2026. Access volume was compared before and after implementation. Patient-level timing metrics were compared between patients evaluated in standard vascular surgery clinic versus multidisciplinary accelerated clinic. Results: Mean monthly access volume increased from 3.08 ± 2.15 to 8.58 ± 3.00 cases after implementation, an increase of 5.5 cases per month ( p < 0.001). Annual access volume increased from 37 to 103 cases ( p < 0.001). Among 53 patients, 29 were evaluated in the standard clinic and 24 in the multidisciplinary clinic. Referral-to-clinic time decreased from 63.6 ± 47.7 to 41.0 ± 35.9 days ( p = 0.01). Clinic-to-operation time did not differ significantly (21.8 ± 18.5 vs 27.1 ± 17.2 days; p = 0.14). Overall referral-to-operation time decreased from 85.4 ± 51.5 to 68.2 ± 43.9 days but did not reach significance ( p = 0.07). Catheter dependence was lower in the multidisciplinary cohort (29% vs 48%; OR 0.36, 95% CI 0.11–1.16). Same-day vein mapping was performed more frequently in the accelerated clinic cohort than in the standard clinic cohort (100% vs 51.7%, p < 0.001). Conclusions: A multidisciplinary accelerated hemodialysis access clinic increased procedural volume and shortened time to surgical evaluation. However, total time to access creation was not significantly reduced, suggesting that downstream operative capacity may remain an important barrier.