Supplementary Material for: Effect of a Quality Improvement Program to Improve Guideline Adherence and Attainment of Clinical Standards in Dialysis Care: Report of Outcomes in Year 1

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.