title: A comprehensive renal vascular access clinic results in improved patient outcomes and reduced costs.
abstract: BACKGROUND
  Management of vascular access for haemodialysis is a leading cause of morbidity and hospitalization in patients with end-stage renal disease. We sought to evaluate the change in admission and procedural outcomes before and after the establishment of a vascular surgeon-led comprehensive renal vascular access clinic (RVAC).
  
  
  METHODS
  A retrospective clinical study was conducted after an RVAC was established in January 2013, with retrospective database created for the 24-month period prior to and after.
  
  
  RESULTS
  The number of inpatient encounters for haemodialysis vascular access care fell over identical time periods before (n = 193) and after (n = 164) the RVAC was established. This reduction was associated with a significant decrease in length of stay (from 10.71 to 3.14 days; P = 0.0056) and thrombosed access procedures (from 32 to 16; P = 0.048). The proportion of emergency procedures fell (from 54.5 to 25.4%; P = 0.002) with a trend towards less arteriovenous fistula formations in the latter group (from 75 to 49; P = 0.099). There was also a trend towards fewer procedures in the latter group (from 195 to 151; P = 0.22). A case-mix costing analysis showed an estimated reduction in mean admission cost from $25 883.15 to $9332.81 for those 2-year periods, equating to a saving of $3.46 million associated with the introduction of the clinic.
  
  
  CONCLUSIONS
  The establishment of an RVAC has led to a variety of objective performance outcome improvements, including a decrease in hospital admission, length of stay, revision and emergency surgeries, with associated cost saving. It reflects positive outcomes observed in other surgical specialties' clinics.
authors.affiliation: Department of Vascular Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia.|Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.|The Vascular Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Shannon D
authors.initials: SD
authors.lastname: Thomas
authors.affiliation: Department of Vascular Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Eugenia C
authors.initials: EC
authors.lastname: Ip
authors.affiliation: Department of Vascular Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Nedal
authors.initials: N
authors.lastname: Katib
authors.affiliation: Department of Renal Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Debbie
authors.initials: D
authors.lastname: Pugh
authors.affiliation: Department of Vascular Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia.|The Vascular Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Lennox
authors.affiliation: Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.|Department of Renal Medicine, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Endre
authors.affiliation: Performance Management Information Unit, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Elaine
authors.initials: E
authors.lastname: Tan
authors.affiliation: Performance Management Information Unit, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Ellery
authors.affiliation: Department of Vascular Surgery, Prince of Wales Hospital, Sydney, New South Wales, Australia.|Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.|The Vascular Institute, Prince of Wales Hospital, Sydney, New South Wales, Australia.
authors.forename: Ramon L
authors.initials: RL
authors.lastname: Varcoe
mesh_terms: D000328:Adult; D000368:Aged; D000554:Ambulatory Care Facilities / Q000191:economics* / Q000458:organization & administration; D001166:Arteriovenous Shunt, Surgical / Q000191:economics / Q000379:methods*; D001315:Australia; D015331:Cohort Studies; D017046:Cost Savings; D005260:Female; D017048:Health Care Costs; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D015397:Program Evaluation; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D062666:Vascular Access Devices / Q000191:economics*
keywords: arteriovenous; clinic; endovascular; fistula; graft; health cost; health service; vascular access; vascular surgery