Abstract
There is limited evidence to guide optimal frequency of surveillance bloodwork for haemodialysis patients. In September 2023, surveillance bloodwork frequency was reduced from monthly to 6-weekly across 4 Illawarra-Shoalhaven dialysis units. We retrospectively evaluated actual frequency of blood tests, safety (all-cause hospitalisations, hospitalisations for hyperkalaemia, percentage of potassium and haemoglobin levels in target ranges), cost-savings and environmental impact (reduction in carbon emissions and waste generation) of 6-weekly versus monthly scheduled bloodwork for clinically stable patients receiving in-facility haemodialysis during the 12-months before and after this practice change. Staff perspectives were gathered via survey. We analysed 99 patients with monthly surveillance bloodwork and 101 patients with 6-weekly bloodwork. After reducing to 6-weekly scheduled bloodwork, frequency of FBC/EUC/CMP blood tests decreased from 48.3 to 34.9 per patient-year. Comparing 6-weekly versus monthly groups, there was no increase in percentage of patients with ≥ 1 hospitalisation (72% vs. 73.5%, p = 0.70), hospitalisation for hyperkalaemia (0.8% vs. 0.9%, p = 0.92); percentage of patients with potassium levels (3.5-5.9 mmol/L) was similar (86.0% vs. 86.2%, p = 0.88). Proportion of haemoglobin levels in target range (100-115 g/L) decreased from 45.4% to 38.5% (p < 0.01) but with no clear changes in Erythropoietin Stimulating Agent use. Overall, there were 3.8 fewer blood draws, 8.7 fewer blood tubes used, $AUD201.44 saved in pathology costs and carbon emissions reduced by 1.03 kg per patient-year. Of 58 dialysis nurses, 47 (81%) responded to a survey and indicated the practice change was acceptable (38/47, 81%). Reducing surveillance bloodwork frequency to 6-weekly for haemodialysis patients delivered substantial cost-savings and had positive environmental benefits without compromising safety. Strong engagement with dialysis staff supports its scalability and sustainability.