Abstract: FR-PO952

Quality Improvement Pilot: A Novel, Personalised, Nurse Led Pathway for Patients Commencing Haemodialysis Shows Improved Outcomes

Session Information

  • Patient Safety
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Patient Safety

  • 1501 Patient Safety

Authors

  • Ashworth, Vicky, Royal Liverpool & Broadgreen University Hospitals Trust, Liverpool, United Kingdom
  • Mccrudden, Alexandra C, Royal Liverpool & Broadgreen University Hospitals Trust, Liverpool, United Kingdom
  • Cole, Peter J, Royal Liverpool & Broadgreen University Hospitals Trust, Liverpool, United Kingdom
  • Sharma, Asheesh, Royal Liverpool & Broadgreen University Hospitals Trust, Liverpool, United Kingdom
Background

Commencing haemodialysis (HD) is a time of physical and psychological distress, with a high incidence of hospitalization. Despite good pre dialysis care many patients experience a suboptimal start to HD. Mortality is at its highest within the first 90 days of commencing dialysis.
Aim: To develop, test and evaluate the impact of a novel, personalised nurse led pathway for patients commencing HD on a range of patient centred process and outcome measures.

Methods

Sequential PDSA cycles were used to develop a personalised nurse led pathway for the first 6 sessions of HD (see fig). Patient distress was recorded at week 2, 4 and 8 using the validated Patient Distress Thermometer (Renal). Baseline control data were retrospectively collected for patients commencing HD from July 2015-June 2016.
Our prospective pilot recruits patients from July 2016-June 2017, and we report 90 day follow-up data.

Results

There were 78 patients in the historic control cohort (mean age 58.4y, 62% male, 45% diabetic). 90 day follow up data are available for 37 patients who started HD using the new pathway (mean age 56.2y, 51% male, 27% diabetic). All outcome measures have improved (see table). Patient distress score has dropped from 4.3 (week 2) to 2.4 (week 8). Patient and staff feedback has been strongly positive.

Conclusion

These data suggest improvements in patient experience and outcomes using this novel intervention.

Improvements in Patient Outcome Measures
 Historic control groupNew patient pathway
% listed for transplant or in work up at 90d21%31%
% definitive vascular access at 90d40%56%
% with home therapy plan at 90d8.5%20%
Days in hospital in first 90d12.2 days8.6 days
Unadjusted 90d mortality5.1%2.7%

Components of nurse led pathway

Funding

  • Private Foundation Support