O46
DEVELOPING AN ADMISSIONS RISK TOOL FOR ADULT PATIENTS RECEIVING
IN CENTRE HAEMODIALYSIS
Preston, R¹, Oliver, D², Hope,W2, Fluck, R3
1
University Hospitals of Leicester NHS Trust, 2East Midlands Renal Network, 3Derby
Hospitals NHS Trust
INTRODUCTION: Adult patients receiving chronic haemodialysis therapy have a high
incidence of emergency admission to hospital. This contributes to reduced quality of life and is
costly for the NHS. We applied for and received funding from the NHS kidney Care Problem
Solving Fund to develop a nurse led admissions risk tool for adult patients undergoing chronic
haemodialysis.
METHOD: We prospectively collected data for a period of 6 months from 121 haemodialysis
patients attending 2 different units in Northamptonshire. The data collected included 5 domains
[demographics, co-morbidity, patient experience via EQ5D, therapy measures and laboratory
data]. The data was entered onto an access database. Statistical analysis was performed using
the student t-test. Factors associated with emergency hospital admission were identified. These
factors were then ‘weighted’ according to the strength of the association with emergency
hospital admission. A simple risk tool was then developed.
RESULTS: There were 54 emergency hospital admissions [36 patients] over the study period.
Eight patients died and a further eight patients changed treatment modality. The factors shown
to be significantly associated with emergency hospital admission are shown in the table below:
Factor
Vascular Access
Weekly HD
Haemoglobin
Albumin
URR
Recent admission
P Value
0.00000025
0.033
0.0000082
0.0051
0.000045
0.05
Comment
AVF v TC
< 12 hours
<10 g/dl
<32 g/l
<60%
Previous admission <42 days
Strength
Strong
Moderate/weak
Moderate
Moderate / weak
Moderate
Moderate / weak
Surprisingly, age and co-morbidity were not shown to be significant factors. The response to the
EQ5D survey was poor and provided insufficient data for analysis. We developed a nurse led
admissions risk tool based on the above results and published data. Each risk factor is weighted,
1-4, with a maximum total score of 10. Any patient with a risk score > 5 are considered to be at
high risk of emergency hospital admission.
CONCLUSION: We have developed a nurse led admissions risk tool to identify haemodialysis
patients most at risk of emergency hospital admission. The significant factors contributing to
this risk have been identified, with vascular access being the single most important factor.
Previous published data have clearly established that age is also an important risk factor for
emergency admission.
Implementation: The next phase of the project commenced in January 2012. Haemodialysis
patients attending units in Derby, Northampton and Kettering will be assessed monthly, using
the risk tool, for a period of 4 months. Patients shown to be at ‘high risk’ of emergency
admission will be identified and interventions to prevent admission implemented. This data will
be collected and analysed and the risk tool validated and modified accordingly.