Dr James Cohen1, Ms Linda Coventry1,2, Dr Wai Hon Lim1, Dr Ashley Irish3,4, Dr Ramyasuda Swaminathan3, Dr Harish Puttagunta3, Ms Kim Tracey4, Dr Khalil Patankar5, Dr Doris T Chan1
1Sir Charles Gairdner Hospital, Nedlands, Australia, 2Edith Cowan University, Joondalup, Australia, 3Fiona Stanley Hospital, Murdoch, Australia, 4Bunbury Hospital, Bunbury, Australia, 5Royal Perth Hospital, Perth, Australia
Biography:
Dr James Cohen is a medical registrar at Sir Charles Gairdner Hospital. Graduating with Honours in biochemistry from the University of Western Australia in 2014, and a Doctor of Medicine from Flinders University in 2019, he started Basic Physician Training at Sir Charles Gairdner Hospital in 2023. He hopes to enter Advanced Training in Nephrology in 2026.
Aim:
To assess acuity among prevalent haemodialysis (HD) patients in Western Australia (WA) and identify factors associated with increased HD acuity.
Background:
With the aging population and presence of complex co-morbidities, there is concern that rising acuity in HD patients is impacting on healthcare service delivery. Patient acuity, reflecting illness severity and nursing care demands, is crucial to planning safe and effective resource allocation. However, HD acuity in prevalent HD patients in WA has not been systematically evaluated.
Methods:
A cross-sectional survey was conducted in 18 WA HD units in 2022 collecting patient demographics, comorbidities and frailty score using the Clinical Frailty Score. HD acuity was determined using the Renal Dialysis Patient Dependency Classification Instrument (RDPDC). Inferential statistics (SPSS v 27) were conducted.
Results:
Of the 1281 prevalent HD patients in WA, RDPDC was completed in 765 (59.8%) patients from 3 tertiary in-centre (n=136), 7 metro satellite (n=405), and 8 country units (n=224). Participants were mostly male (60.2%) with an average age of 63.4 (SD 15.7) years. Only 25% were in the standard acuity category, with 32% intermediate and 42% in the high acuity category. The high acuity cohort were oldest (median 65.7 years), followed by intermediate (64.9 years) then standard (62.2 years) (P=0.003). Patients with higher acuity were more commonly female (p=0.02), diabetic (p<0.001), had cardiovascular disease (p<0.001), dialysed in-centre or regional unit (p=0.001) and had increased frailty (p<0.001).
Conclusions:
High patient acuity is prevalent among HD patients in WA, particularly in in-centre and regional HD units. These findings highlight a need to re-evaluate staffing models, care delivery frameworks, and resource distribution to meet escalating care demands to ensure safe, high-quality HD services.
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