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Abstract: FR-PO531

Quality Improvement Strategies to Reduce Peritoneal Dialysis Catheter Insertion Wait Times: A 10-Year Experience

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Auguste, Bourne L.A, Sunnnybrook Heatlh Sciences Centre, Toronto, Ontario, Canada
  • Girsberger, Michael Yannik, Toronto General Hospital, Toronto, Ontario, Canada
  • Ibrahim, Ali Z., Toronto General Hospital, Toronto, Ontario, Canada
  • Abreu, Zita C., Toronto General Hospital, Toronto, Ontario, Canada
  • Bargman, Joanne M., Toronto General Hospital, Toronto, Ontario, Canada
Background

Bedside peritoneal dialysis (PD) catheter insertions have been effective in reducing wait-times, however laparoscopic insertions are still needed in patients with prior abdominal surgeries, high risk of leaks and hernia repairs. Our study aim was to assess the impact of local quality improvement initiatives on wait-times for laparoscopically inserted PD catheters over a 10-year period.

Methods

We reviewed our database at the Toronto General Hospital for laparoscopic wait-times for PD catheter insertions between January 1, 2008 to December 31, 2018. Wait-times for catheter removals, manipulations and hernia repairs were reviewed. Buried PD catheters were excluded from analysis. A control chart analysis of mean quarterly wait-times for laparoscopically inserted PD catheters was performed. We captured the effect of three local interventions on wait times: interventional radiology program (fluoroscopic-guided), bedside insertion program and transition to becoming a centre of regional practice, wherein patients from other parts of the province were referred to us for more complex catheter procedures.

Results

A total of 379 new patients had laparoscopically inserted catheters between 2008 and 2018. Quarterly mean wait-time for catheter insertion was between 21.3 to 28.5 days (Figure 1). After becoming a regional centre of practice in 2016, mean wait-time for new insertions increased dramatically to 39.3 days. There was no change in access to operating room (OR) time during this period. After 2016, there was a 56.4 % increase in external patients receiving procedures at our institution without increase in access to OR time. 51% of procedures were hernia repairs, catheter manipulations along with removal and reinsertion.

Conclusion

Quality improvement strategies may initially help to reduce wait-times for PD catheter insertions. However, long-term success of these improvement strategies must be supported with administrative policies that lead to proportional increases in access to OR time.

Figure 1