QI Repository

This resource aims to allow for increased awareness on the QI projects being done in Canada, reduce project redundancy, and foster collaboration across sites and provinces. If you would like to have your project listed in the QI Repository, please click here to submit your project for inclusion.

Site/Region	Name	Email	Phone	Topic	Project Description	Aim Statement	Project Lead Name	Project Lead Position/Title	Project contact method	Project Contact Email	Project Contact Phone	Project Status	Conclusions	Notes	Supporting Documentation / Files
BC	Krishna Poinen	kpoinen@gmail.com	1-604-505-9733	HHD, PD	Cross-sectional survey of multidisciplinary renal team members across five renal programs in British Columbia, Canada. The survey contained questions regarding primary work area, modality preference, patient and system factors that may influence modality candidacy, perceived knowledge of home therapies and need for further education.	Our objective was to evaluate the perceptions of all renal team members towards home dialysis therapies.	Krishna Poinen	MD	Email & Phone	kpoinen@gmail.com	1-604-505-9733	Completed	The majority of multidisciplinary team members, including allied health staff, acknowledged the benefits of home therapies. There were significant discrepancies amongst team members regarding patient/system-level factors that may impact home therapies candidacy. Structured, focused and repeated education sessions for all renal team members may help to address misperceptions around factors that influence modality candidacy.	Kidney360. DOI https://doi.org/10.34067/KID.0006222020
ON	Sam Silver	Samuel.silver@queensu.ca	613-549-6666 x4895	HD	Routine labs changed from Q-4 weeks to Q-6 weeks	To decrease the frequency of HD labs without affecting patient outcomes or quality of care	Sam Silver/Ed Ilescu N/A	MD	Email	Samuel.silver@queensu.ca		Completed	The reduced lab frequency resulted in cost-savings to the dialysis program, without affecting anemia or phosphate targets. There was also no change in all-cause mortality. This may allow the healthcare team to focus less on labs and more on other health issues that matter to patients (e.g., symptom control)	Please refer to attached publications
ON	Sam Silver	Samuel.silver@queensu.ca	613-549-6666 x4895	HD	Creation of dedicated chairs in the in-centre unit for patients new to dialysis. This includes 1:1 nursing care and early follow-up with modality educator, access nurse, dietician, and pharmacist. Patients are not moved out of this area until long-term kidney plan has been made and patient is clinically stable, as per physician assessment.	To increase the # of patients starting home dialysis	Sam Silver/Claire Kennedy N/A	MD	Email	Samuel.silver@queensu.ca		Ongoing	This model of care was feasible in a dialysis unit without dedication of additional resources. Ideally, new starts could be dialyzed in their own separate room if resources permit. Next steps include using the model to improve mental health and prevent rehospitalizations during the transition to dialysis.	Please refer to CSN poster for further details
AB	Priyanka Mysore	pmysore@hsc.mb.ca	2045886113	HD	Multifaceted QI initiative to reduce lab test overuse on the nephrology ward	Reduce the overuse of 'daily' lab tests and routine creatinines byt 20% on chronic dialysis patients admitted to the nephrology ward over 3 months	Priyanka/Pam Mysore/Mathura	QI lead	Email	pmysore@hsc.mb.ca		Completed	We successfully reduced the use of routine creatinines and 'daily' lab orders with sequential PDSA cycles.	Project took place 2017-2018.
AB	Veronica Hammer	veronica.hammer@albertahealthservices.ca	(403) 944-2146	PD	Retrospective chart review to describe participants and outcomes in people who utilized aPD in AKC-S since its inception in 2011 to December 31, 2021	To describe the outcomes of participants of an aPD program in Alberta, Canada.	Veronica Hammer	Project Lead	Email	veronica.hammer@albertahealthservices.ca		Completed	Assisted peritoneal dialysis provides a service to patients who are unable to perform PD independently. It is an excellent alternative to in-center hemodialysis which not only allows patients to maintain their independence in the community, but it can facilitate the uptake of independent PD in a significant proportion of participants	On average, patients stayed on aPD for 407 ± 642 days. Reasons for discontinuing aPD included death (27.4%), switching to hemodialysis (26.7%), becoming independent on peritoneal dialysis (24.4%), transplant (3%), palliative care (3%), and relocating outside the program catchment area (3.7%). Among those who switched to independent PD, they maintained it for an additional 427 ± 400 days.	P-016-HAMMER_Veronica.pdf
QC	Daniel Blum	daniel.blum@mcgill.ca	5147582586	Hemodialysis	A carefully selected subset of dialysis patients may tolerate relative underdialysis for a period of time, thus limiting exposure risk during times of heightened viral transmission during the pandemic.	Prevent nosocomial transmission of COVID-19 in hemodialysis recipients by limiting dialysis frequency in order to reduce exposure risk	Daniel Blum	Nephrologist	Email	daniel.blum@mcgill.ca		Completed	A carefully selected subset of chronic HD recipients can tolerate relative underdialysis for a 2-3 month duration. Rigorous surveillance and interdisciplinary interventions can prolong the duration that underdialysis is tolerated for.	Implementing a permissive underdialysis strategy early during the pandemic provided high-value care that was patient-centered, efficient, and safe. This strategy was utilized in the first and second waves of the COVID-19 pandemic, and helped to prevent nosocomial transmission of the pandemic respiratory virus during periods of heightened viral transmission. Complications are as expected and included volume overload, hyperkalemia, and mild uremic symptoms, which were manageable. Over 400 hospital encounters were spared using this strategy. See the attached slideset for further details.	Permissive-Underdialysis-slides-for-CSN.pdf
ON	Parnian Riaz	parnianriaz92@gmail.com	1905-522-1155	CKD	We used an interrupted time series design to conduct this quality improvement study. Three interventions were implemented from November 16, 2021, to February 28, 2022: posting education posters in general nephrology clinics that outlined the ORN referral criteria, auditing and providing feedback to individual nephrologists regarding their referral rates, and implementing nurse-generated MCKC referrals as part of general nephrology clinic workflow.	The primary outcome measure was the percentage of eligible patients referred at each eligible visit in 2-week intervals. The process measure was the percentage of nursing-led referrals created and accepted. The balancing measure was MCKC clinic wait times. We monitored these measures from March 1 to September 15, 2022.	Parnian Riaz	Project Lead	Email	parnianriaz92@gmail.com		Completed	With interventions that involved multidisciplinary collaboration, we successfully improved our MCKC referral rate and are closer to reaching the provincial target.	Provincial data provided by ORN demonstrated that from January 1 –December 31, 2021, only 51% of eligible patients were referred to MCKC. After our interventions, the mean referral rate for eligible patients at each visit increased from 9.9% to 31.3% and the overall referral rate increased from 51% to 68%. Our process measure showed that the mean completion rate for nursing-based referrals was 93.1% and the physician acceptance rate for referrals was 57.6%. The wait time for MCKC clinics did not change during this time.	P-043-RIAZ_Parnian.pdf
MB	Izabella Supel	umsupel@myumanitoba.ca	1204-787-1524	HD	Standardized pre-procedural work up for fistulograms and tunnelled catheters (F/TC) lacks supporting evidence to minimize adverse events, and may be a source of unnecessary resource use. With input from all stakeholders, a value stream map was created removing any non-value-added steps, including CXRs and ECGs. Our first PDSA cycle eliminated CXRs and ECGs from the process for all in centre hemodialysis patients at our centre. After three months, the second PDSA cycle expanded our intervention to outpatient clinics, home hemodialysis, and all satellite units. A survey was administered to stakeholders to ascertain satisfaction with the revised process	To determine if elimination of CXRs and ECGs from preprocedural workup for F/TC will have adverse effects, improve workplace efficiency, and yield cost-savings.	Izabella Supel	Project Lead	Email	umsupel@myumanitoba.ca		Completed	F/TC are considered lower-risk procedures and we observed that it is safe to eliminate pre-procedural workup of CXR and ECGs at our local level. Elimination of these tests also reduced staff workload and has led to cost savings.	CXRs and ECGs elimination showed cost savings, no further adverse effects, and was perceived as a positive change by stakeholders	P-044-SUPEL_Izabella.pdf
AB	Warda Munawar	wardamunawar@hotmail.com	1403-210-6766	HD	Comparing traditional dialysis unit vs transitional unit on patient experience via GAD-7 and PHQ-9 scores	To compare patient-reported outcome measures for anxiety (GAD-7) and depression (PHQ-9) between the DTU and a traditional facility-based HD unit (HDU).	Warda Munawar	Project Lead	Email	wardamunawar@hotmail.com		Completed	Patients have a high degree of anxiety and depressive symptoms at HD initiation, which improve with time. There was no difference in depression or anxiety symptoms between DTU and HDU. Further studies need to characterize the support needs for people initiating dialysis.	Of a total of 26 DTU and 26 HDU participants, both had significant improvement in GAD-7 and PHQ-9 scores at 2 weeks, potentially more home therapies transitions at 6 months with DTUs	P-061-MUNAWAR_Warda.pdf
MB	Anirudh Agarwal	anirudh.k.agarwal@gmail.com	1204-787-1524	CKD	Literature review for native renal biopsy best practices, and creation of a new evidence-based renal biopsy package to reduce unnecessary testing/redundancies	(1) Identify guidelines and evidence-based practices which should guide renal biopsies (2) Liaising with stakeholders: develop a new renal biopsy package to reduce unnecessary testing, redundancies, and evidence-based (3) Evaluate the efficacy of the new package.	Anirudh Agarwal	Project Lead	Email	anirudh.k.agarwal@gmail.com		Ongoing	At this stage, the process of implementing the forms is underway, and data collection and analysis are pending	Literature has identified certain parameters for reduction of renal biopsy complications; novel renal biopsy package in planning stages	P-062-AGARWAL_Anirudh.pdf
Site/Region												Project Status