The Fistula First Catheter Last (FFCL) is a coalition of vascular access experts and stakeholders who are committed to the development and implementation of sustainable system changes that support arteriovenous (AV) fistula placement in suitable hemodialysis patients, while reducing central venous catheter use.
FFCL Mission Statement
The Fistula First mission is to improve the survival and quality of life of hemodialysis patients by optimizing vascular access selection – which for most patients will be an AV fistula – to lower infection, hospitalization and mortality rates while preserving vital Medicare resources.
Principles for Change
AV Fistula First aims to build on prior work, and has taken advantage of system-level diagnosis and strategies for improvement.
The following list summarizes the key principles that governed the development of “change strategies” for the project:
- Core strategies and tools that address the fundamental “failure” points in the system that can be adopted easily.
- Focus on “spreading” successful ideas on a Network and national scale.
- Collaboration – among patients, Networks, providers and key healthcare professionals.
- Leveraging of resources, including Network QI resources and other relevant sources of expertise and support from the FFCL Coalition membership.
- Minimizing burden on dialysis facilities and practitioners
- Mission Statements and Activities of the FFCL Coalition
- Increase AV fistula utilization in all appropriate hemodialysis patients to 68%
- Decrease the use of long term catheters (>90 days) to < 10%
- Engage patients, the ESRD Networks, the renal community, providers, clinicians and stakeholders to work together to achieve the goals
Products of the FFCL Coalition
The Centers for Medicare and Medicaid established the National Access Improvement Initiative (NVAII) in 2003 which in 2005 became the Fistula First Breakthrough Initiative (FFBI). The members of the FFBI Coalition worked together to create a toolkit to support the work of the ESRD Networks and renal community in improving vascular access for hemodialysis patients with a focus on increasing the percentage of AVFs in use. All documents were created and/or modified by coalition members, and reviewed and edited by the coalition. The Fistula First branded documents can be customized for your own facilities and/or practice.
The FFBI transitioned to the Fistula First Catheter Last Workgroup Coalition (FFCL) to focus on the development of tools and resources to help dialysis facilities and clinicians reduce catheters and increase AV fistula rates in hemodialysis patients.
In addition, other organizations and individuals have developed tools in the course of their improvement efforts – for example, successful protocols, order sets and forms, instructions and guidelines for implementing key changes – and are making them available here for others to use or adapt in their own organizations.