Change Concept 4
Surgeon selection based on best outcomes, willingness, and ability to provide access services
- Nephrologists communicate standards and expectations to surgeons performing access, e.g., K/DOQI minimal standards for AVF placement, and training in current techniques for AVFs.
- Nephrologists refer to surgeons willing and able to meet the standards and expectations.
- Surgeons are continuously evaluated on frequency, quality and patency of access placements. Data collection ideally is initiated and reported at the dialysis center as part of ongoing CQI process, and can be aggregated at the Network level.
Collect data on the surgeons in your community to find out who has the skills and interest in placing fistulae. Choose surgeons who are willing and able to do AV fistula construction.
Changes for Improvement:
Communicate AVF Expectations to Surgeons
Nephrologists should communicate expectations to surgeons regarding AV fistula placement and their ability to use current AV fistula surgical techniques, based on K/DOQI Guidelines and best practices.
Refer to Surgeons Willing and Able to Meet AVF Expectations
Nephrologists should refer to surgeons who are willing and able to meet AVF expectations based on K/DOQI Guidelines and best practices.
Evaluate Surgeons on the Frequency, Quality, and Patency of Access Placements
Data collection and outcomes tracking can be initiated and reported at the dialysis center as part of ongoing CQI processes, and may be aggregated at the ESRD Network level. Nephrologists can also potentially track the data for their patients themselves.
Related Tools
From: National Vascular Access Improvement Initiative, National Coordinating Center
Los Angeles, California, USA
Some surgeons are willing and able to perform the necessary evaluative and surgical procedures necessary for establishing successful arteriovenous (AV) fistulae. This questionnaire can be used to survey the surgeons in your community about their skills, experience, and interest in order to determine which surgeons are most appropriate to perform AV fistula procedures.