Reducing Time to Permanent Hemodialysis Access Creation for End-Stage Kidney Disease (ESKD) Patients
Care Continuum
Care Process & Redesign
National Healthcare Group Quality Improvement
National Healthcare Group
24 December 2025
To decrease median time from referral to permanent vascular access creation in ESKD patients initiated on dialysis via a. The interventions were effective in reducing the time to access creation, thus addressing a significant problem in patient care.
Year Submitted: 2025
Published Date: 24 December 2025
Tags: Care Process ＆ Redesign, Workflow Redesign, Time Saving, Cost Saving, Quality Improvement, Productivity, Access To Care, Waiting Time, Care Continuum, End-Of-Life Care
About this Content
Aims
To decrease median time from referral to permanent vascular access creation in ESKD patients initiated on dialysis via a tunnelled dialysis catheter (TDC) from 142 days to 40 days over a sustained period.
Background
Singapore is currently number 3 worldwide for diabetes-induced kidney failure, with 6 new patients starting dialysis daily. Up to 80% of new ESKD patients in Singapore are initiated via a TDC. International data assessing time from referral to access creation surgery ranged from 5-6 days (Italy/Japan/Germany) to 40-43 days (Canada/United Kingdom). A sample of 80 patients in our institution from May to October 2023 showed a median time from referral to access creation of 142 days, with only 3% successfully undergoing surgery in 40 days from referral. The risk of catheter-related complications is highest during the first 90 days of catheter placement.
Methods
Intervention 1: Vascular Surgeon to Review & List Patient for Surgery on Same Day of Clinic TCU. Intervention 2: Established Criteria and Workflow for Inpatient Referral for AVF Creation.
Results
Reduction in the median time from referral to access creation from 142 days to 96 days post-intervention.
Conclusion
The interventions were effective in reducing the time to access creation, thus addressing a significant problem in patient care.
Lessons Learnt
Initial increased stress on outpatient load due to rearrangement of appointments and increased workload on the inpatient team, which were balanced by reduced clinic load and waiting time.
Keywords
Hemodialysis, ESKD, AVF creation, dialysis, vascular access
Innovators' Details
Innovators' Details
Healthcare Cluster(s) | National Healthcare Group |
Organization(s) Involved | Tan Tock Seng Hospital |
Platform(s) | National Healthcare Group Quality Improvement |
Healthcare Professional Group(s) | Medical |
Applicable Specialty or Discipline | Nephrology, Surgery |
Project Lead(s) | Timothy Koh, Malcolm Mak |
Project Member(s) | Pan Ying |
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Group Quality - nhggroup.QRM@nhghealth.com.sg