title: Effect of a Quality Improvement Program to Improve Guideline Adherence and Attainment of Clinical Standards in Dialysis Care: Report of Outcomes in Year 1.
abstract: BACKGROUND
  Best practice in dialysis is synthesised in clear international guidelines. However, a large gap remains between the international guidelines and the actual delivery of care. In this paper, we report outcomes for the first year of a multifaceted dialysis improvement programme in our network.
  
  
  METHODS
  One year collaborative involving 3 haemodialysis units and a peritoneal dialysis (PD) programme involving 299 dialysis patients. Each unit addressed a different indicator (unit A - catheter-related bloodstream infection [CRBSI], unit B - pre-dialysis blood pressure [BP], unit C - dialysis dose, unit D - anaemia) with a shared aim to match the top 10% in the UK. Tailored multifaceted approaches include a modified collaborative methodology with an aim, framework, driver diagram, learning sessions, facilitated meetings, plan-do-study-act cycles and continuous measurement. Analysis of outcomes, costings, erythropoietin stimulating agent and iron use, and safety culture attributes.
  
  
  RESULTS
  Unit A reduced CRBSI from 2.65 to 0.5 per 1,000 catheter days (p = 0.02). Unit B improved attainment of target BP from 37.5 to 67.2% (p = 0.003). Unit C improved attainment of target urea reduction ratio from 75.8 to 91.4% (p = 0.04). PD unit D improved attainment of target haemoglobin from 45.5 to 62.7% (p = 0.01), with no significant change in the indicators in a non-intervention unit. Safety culture attributes improved. Costs associated with admission for fluid overload and infection, erythropoietin, iron and thrombokinase use decreased 36% (£415,620-£264,143).
  
  
  CONCLUSIONS
  Units that took part in this collaborative improved guideline adherence compared both to their own pre-intervention performance and a non-intervention unit. Such multifaceted interventions are a useful methodology to improve dialysis care.
authors.affiliation: Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK.
authors.forename: Sajeda
authors.initials: S
authors.lastname: Youssouf
authors.forename: Azri
authors.initials: A
authors.lastname: Nache
authors.forename: Chandrakumaran
authors.initials: C
authors.lastname: Wijesekara
authors.forename: Rachel J
authors.initials: RJ
authors.lastname: Middleton
authors.forename: David
authors.initials: D
authors.lastname: Lewis
authors.forename: Aladdin E
authors.initials: AE
authors.lastname: Shurrab
authors.forename: Edmond
authors.initials: E
authors.lastname: O'Riordan
authors.forename: Lesley P
authors.initials: LP
authors.lastname: Lappin
authors.forename: Donal
authors.initials: D
authors.lastname: O'Donoghue
authors.forename: Philip A
authors.initials: PA
authors.lastname: Kalra
authors.forename: Janet
authors.initials: J
authors.lastname: Hegarty
mesh_terms: D001794:Blood Pressure; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000517:prevention & control; D003695:Delivery of Health Care; D004921:Erythropoietin / Q000097:blood; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007501:Iron / Q000097:blood; D008297:Male; D010353:Patient Education as Topic; D061214:Patient Safety; D058996:Quality Improvement; D006435:Renal Dialysis / Q000009:adverse effects / Q000191:economics / Q000592:standards*; D013222:State Medicine; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D004921:Erythropoietin; D007501:Iron
keywords: Clinical standards; Dialysis; Outcomes; Quality; Quality improvement