Patients with End Stage Renal Disease (ESRD) undergoing Haemodialysis (HD) require some of the most complex care in medicine. A functioning vascular access is critical to the delivery of life-saving HD therapy in these patients. Between 2017 to 2019, approximately 23% of HD-related admissions were attributed to vascular access dysfunction. These patients were often admitted for angioplasty and/or thrombolysis of their vascular access.
A Value Driven Care initiative was started in 2022 to measure outcomes and cost related to angioplasty and thrombolysis of dysfunctional vascular accesses. Analysis found that patients admitted non-electively have an average wait time of 2 days before receiving the procedure. This project aims to reduce hospitalization stay by reducing waiting time to procedure, and avoidance of admission for patients presenting to SGH Emergency Department with a thrombosed vascular access through a day surgery protocol. This group of patients was typically admitted due to the perceived higher risks and need for close monitoring. With clinical evaluation, a protocol was designed to send eligible patients home from the Emergency Department. Patients will re-present the following day instead for day procedure, receiving thrombolysis and being discharged within the same day.
