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Kidney Week

Abstract: FR-PO725

Improving Rate of Access Placement for Inpatients with eGFR Less Than 20 mL/min/1.73 m2

Session Information

Category: Dialysis

  • 704 Dialysis: Vascular Access


  • Burke, Peter, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
  • Katz Greenberg, Goni, Thomas Jefferson University and Hospital, Philadelphia, Pennsylvania, United States
  • Brahmbhatt, Yasmin G., Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States

The most common form of renal replacement therapy in the US is hemodialysis (HD) which requires Arterio-Venous (AV) access placement. Challenges with obtaining timely permanent AV access include late referral to nephrology and vascular surgery, patient non-compliance, and lack of effective patient pathways. Baseline data at our institution for inpatients with eGFR < 20 ml/min, revealed there was a greater prevalence of patients without permanent AV access for HD initiation compared to national data. Using Quality Improvement (QI) methodology and interventions, we aimed to improve AV access creation in this population.


Over a three month period on five medicine teaching services, residents were given a protocol to order venous mapping, consult nephrology and vascular surgery for all patients with an eGFR<20 ml/min. The vascular team established care and scheduled outpatient appointments for permanent HD access. The nephrology fellows scheduled follow up appointments and conducted post-discharge physician phone calls. Baseline data was collected on patients with an eGFR< 20 ml/min who were discharged without initiation of HD including readmitted patients over a 3 month period.


The study population had a greater rate of AVF/AVG present at 62% compared to the baseline data at 23% and did not significantly alter the length of stay (Table 1).


Hospitalizations are stressful and making decisions regarding long term care can be difficult. Follow-up physician phone calls allowed care teams to speak to patients when they were more receptive and motivated to make healthcare decisions. This improved patient compliance and follow-up rates, and resulted in timelier AV access rates without adversely affecting length of stay. Study limitations included the time-intensive nature of care coordination, lack of a transitions of care coordinator and the structure of patient capture. We conducted a successful QI intervention in a limited pilot project. Creating an effective patient pathway for inpatients with advanced CKD can increase rates of AV access placement without significantly increasing length of stay.

Vascular Access Rate and Length of Stay
Transitions of Care CategoryBaseline Data
Study Population
AVF/AVG Present23%62%
Average Length of Stay8.31 days8.4 days