Sydney Dialysis Centre manages 155 home haemodialysis patients throughout NSW. The distribution of patients is: 70% Sydney Metropolitan and 30% rural NSW. The service provides telephone support 24hour per day, seven days per week. Each telephone call is logged as an Occasion of Service (OOS). In addition an OOS report is documented and filed in the patient’s medical record. Each month the number of OOS calls are collated and submitted to the Department of Health as activity statistics.

A six month audit of OOS was conducted and calls were categorised to group commonalities, training location and rural/metro split. Percentage calculations were completed for each category. Four major groups were identified: 1) Clinical; 2) Technical; 3) Nursing/Administration; and 4) Stores. The following subcategories were identified under Clinical: Access; Modality; Dialysis Management; Troubleshooting; and Anticoagulation.

This audit has provided the opportunity to: document the nature of the calls; identify trends; recognise shortfalls in the training program; utilise information to feedback into the training program; and ultimately improve patient outcomes.

Preliminary findings suggest that once a patient is discharged from the home training program vigilant follow up is important in keeping the patient well dialysed and at home. Surveillance in areas such as: access, ideal body weight, blood results and technique is essential. Recognition of the need for additional home visits, retraining and/or respite is also important.

We plan to repeat the audit biannually to graph trends and implement a continuous quality improvement program.