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Fistula First Catheter Last


medical staff with elderly female patient smilingThe work of the Fistula First Catheter Last (FFCL) Workgroup Coalition is focused on supporting the renal community, the End Stage Renal Disease (ESRD) Networks, patients, and the Centers for Medicare & Medicaid Services (CMS) in efforts to improve vascular access outcomes.

In 2003, CMS established the National Access Improvement Initiative (NVAII), which included vascular access experts and renal stakeholders who were committed to the development and implementation of sustainable system changes to support arteriovenous fistula (AVF) placement in suitable hemodialysis patients.

In 2005, the NVAII became the Fistula First Breakthrough Initiative (FFBI) Coalition. Together, the members of the FFBI Coalition developed a toolkit intended to support the work of ESRD Networks and renal community in improving vascular access for hemodialysis patients. All documents created and/or modified as part of the FFBI Coalition are branded as Fistula First (FF), and can be customized for your own facilities and/or practice.

In 2015, the FFBI Coalition transitioned to the FFCL Workgroup Coalition, which included an enhanced focus on reducing of central venous catheter (CVC), in addition to continuing to support the development of tools and resources to help dialysis facilities and clinicians increase AVF rates in hemodialysis patients.

The FFCL 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.

The FFCL vision is to serve as a coalition of vascular access experts and stakeholders who are committed to the development and implementation of sustainable system changes that support AVF placement in suitable hemodialysis patients, while reducing central venous catheter use.

The FFCL Workgroup Coalition goals include:

  • Increasing AV fistula utilization in all appropriate hemodialysis patients to 68%.
  • Decreasing the use of long term catheters (>90 days) to < 10%.
  • Engaging patients, the End Stage Renal Disease (ESRD) Networks, the renal community, providers, clinicians, and stakeholders to work together to achieve the goals.

FFCL Workgroup Coalition 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 ESRD Network quality improvement resources and other relevant sources of expertise and support from the FFCL Workgroup Coalition membership.
  • Minimizing burden on dialysis facilities and practitioners.
  • Mission Statements and Activities of the FFCL Workgroup Coalition.