Access Risk Score

We recently added a new feature that combines all the results of our data analysis into an Access Risk Score (ARS) to even further help prioritize the patients who are at high risk for thrombosis or conversion to a CVC. This feature also provides a prioritization list of patients based on highest Access Risk Score numbers.

Recently 26 facilities that used the base Vasc-Alert service conducted an analysis. 14 started utilizing the Access Risk Score and 12 did not. This analysis was done recently so all units were dealing with COVID as well. A key take-away from the document is the group of facilities using the Access Risk Score reduced its thrombectomies and conversions by 38%.

Open

Introduction:  In an effort to increase timely vascular access referrals, Vasc-Alert developed the access risk score[1] to help prioritize the patients on alert so that clinical staff can more efficiently determine which patients should be considered for referral. A report of patients on-alert ranked by the access risk score (the triage list) is available weekly to clinical staff. Our assumption was that making Vasc-Alert easier to use and providing a means to prioritize patients on-alert will improve vascular access care. To assess the actual impact of the access risk score and the triage list on access outcomes, we examined two groups of facilities already using Vasc-Alert: one using the triage list and the other not using the triage list (control group). Indications of access failure (thrombectomies performed and conversions inferred from the treatment data) and proactive angioplasties were tallied for both groups.

Method:  14 facilities (740 AV patients) that use Vasc-Alert and send their patients to an access center, implemented the triage list in mid-April 2020. Intervention data was examined in the four months prior to implementation (December through March), and the four months following implementation (May through August)[2].  A comparable group of 12 facilities (450 patients) that use the same access center but not the triage list was examined in a similar manner.

Results:  Thrombectomies and conversions decreased 38% for the facilities that implemented the triage list (42 to 26), while increasing 20% in the facilities that did not (10 to 12). Angioplasties increased 10% for those using the triage list (104 to 115), while decreasing 6% in the facilities that did not (84 to 79).

Open

Discussion: The difference in outcomes and types of procedures performed by the two groups of facilities supports the initial assumptions that the triage list makes Vasc-Alert easier to use and the access risk score helps prioritize patients for referral. Furthermore, with the Covid-19 crisis putting additional requirements on facility staff there is even less time for tasks that improve quality of care, so it is not surprising that the number of referrals in the control facilities went down and the number of patients with thrombosis went up. In contrast, the facilities that used the triage list showed improvement in both areas. The ease of use of the triage list in a clinical setting to make timely referrals holds strong promise for improving the quality of access care for hemodialysis patients. Additionally, the access risk score provides an objective criterion for establishing a protocol for making proactive referrals for intervention.

[1] The access risk score uses five factors derived by the Vasc-Alert equations to determine the relative risk for an access complication on a 1 to 10 risk scale.

[2] One facility implemented the triage list in September 2019 and was examined in a similar manner, except the time period was 11 months prior and 11 months after.