Hyper Acute Dialysis Access Pathway (HADAP) - Undertaking Creation of Arteriovenous Fistulae in The Renal Ward

Abstract Introduction The impetus to apply the “lean method” to creation of arteriovenous fistulae came with the pandemic restricting access to theatres. Here we present HADAP implemented in a dedicated procedure room in the Renal ward. Method Between April and September 2020, 44 patients underwent ward-based arteriovenous fistula operations with no more than 3 people in the room – surgeon, runner and patient. The parameters assessed were duration of operation, complications, patency, patient and surgeon feedback and financial implications. Results The service was predominantly registrar-led who created 91% of the fistulae. 95% operations were completed successfully with a 2-week primary patency of 73% and no surgical site infections. 40% of the procedures were radiocephalic fistulae. 14% procedures required surgical assistance by the runner. The average operating time reduced from 90 minutes for the first 10 cases to 50 minutes for the last 9. A structured questionnaire showed positive feedback from both patients and surgeons (4-5 out of 5). This service has cleared potentially 9 main theatre lists for more complex procedures. Conclusions Our study demonstrates the successful implementation of a novel operating environment allowing expedited care for renal failure patients. It has enhanced our ability to deliver a dialysis access program despite the challenges of COVID.