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. 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.