Successful Multidisciplinary Interventions for Arterio-Venous Fistula Creation by the Pacific Northwest Renal Network 16 Vascular access Quality Improvement Program

Background In 2002, the Center for Medicare and Medicaid Services (CMS) required all 18 Renal Networks to participate in a Vascular Access Quality Improvement Program (QIP). The Northwest Renal Network (NWRN 16) chose to increase arteriovenous fistula (AVF) use. NWRN 16 hypothesized that strategies which targeted the improvement of AVF rate and the reduction of catheter use were the same. In December 2001, 44.2% of hemodialysis (HD) patients in the NWRN 16 received HD using an AVF which met the Dialysis Outcome Quality Initiative (K/DOQI) 40% AVF guideline for prevalent patients. However, 43% of HD facilities (2869 patients) had less than 40% of AVF and higher HD catheter rates than the average Network catheter rates (25.0 vs. 20.3%). To address the needs of underperforming facilities, NWRN 16 provided education and tools for their vascular access decision makers to promote AVF creation and catheter reduction. Methods In 2002, NWRN 16 sponsored four regional workshops targeted at nephrologists, vascular surgeons, HD nurses, and interventional radiologists. Results Percentage of AVFs in use in invited facilities increased from 31.3% pre-intervention to 56.2% at 4 yrs: 78% increase (99% confidence interval: 77.8% to 81.5%). Percentage of catheters increased from 25% to 25.8%: 3.2% change over 4 yrs (99% confidence interval: 2.5% to 4%). Conclusion The success of Network 16's AVF interventions demonstrates the effectiveness of Network education promoting multidisciplinary teamwork, and innovative strategies to increase dramatically AVF use without substantial increase in catheter use.

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About the National VA Surgical Quality Improvement Program

PsycEXTRA Dataset ◽

10.1037/e578552006-001 ◽

1998 ◽

Cited By ~ 1

Author(s):

Jennifer Daley

Keyword(s):

Quality Improvement ◽

Quality Improvement Program ◽

Improvement Program ◽

Surgical Quality

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Preoperative Risk Factors and Surgical Complexity Are More Predictive of Costs Than Postoperative Complications: A Case Study Using the National Surgical Quality Improvement Program (NSQIP) Database

Yearbook of Surgery ◽

10.1016/s0090-3671(08)70310-0 ◽

2006 ◽

Vol 2006 ◽

pp. 16-17

Author(s):

E.M. Copeland

Keyword(s):

Risk Factors ◽

Quality Improvement ◽

Postoperative Complications ◽

Quality Improvement Program ◽

Preoperative Risk ◽

Improvement Program ◽

Surgical Quality ◽

Preoperative Risk Factors ◽

Surgical Complexity

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Upper Extremity Free Flap Transfers: An Analysis of the National Surgical Quality Improvement Program Database

Journal of Hand and Microsurgery ◽

10.1055/s-0040-1717828 ◽

2020 ◽

Author(s):

George A. Beyer ◽

Karan Dua ◽

Neil V. Shah ◽

Joseph P. Scollan ◽

Jared M. Newman ◽

...

Keyword(s):

Quality Improvement ◽

Upper Extremity ◽

Free Flap ◽

Quality Improvement Program ◽

Readmission Rates ◽

Improvement Program ◽

Surgical Quality ◽

Flap Transfer ◽

Free Flap Transfer ◽

Reoperation Rates

Abstract Introduction We evaluated the demographics, flap types, and 30-day complication, readmission, and reoperation rates for upper extremity free flap transfers within the National Surgical Quality Improvement Program (NSQIP) database. Materials and Methods Upper extremity free flap transfer patients in the NSQIP from 2008 to 2016 were identified. Complications, reoperations, and readmissions were queried. Chi-squared tests evaluated differences in sex, race, and insurance. The types of procedures performed, complication frequencies, reoperation rates, and readmission rates were analyzed. Results One-hundred-eleven patients were selected (mean: 36.8 years). Most common upper extremity free flaps were muscle/myocutaneous (45.9%) and other vascularized bone grafts with microanastomosis (27.9%). Thirty-day complications among all patients included superficial site infections (2.7%), intraoperative transfusions (7.2%), pneumonia (0.9%), and deep venous thrombosis (0.9%). Thirty-day reoperation and readmission rates were 4.5% and 3.6%, respectively. The mean time from discharge to readmission was 12.5 days. Conclusion Upper extremity free flap transfers could be performed with a low rate of 30-day complications, reoperations, and readmissions.

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