A defined peritonitis clinical pathway in the emergency department improves outcomes for peritoneal dialysis patients

Background Peritonitis is the most common infection and cause of treatment failure for patients receiving peritoneal dialysis (PD). Peritonitis can be life-threatening if treatment is not initiated in a timely manner. We have identified in our facility that patients presenting to the emergency department (ED) with peritonitis often have delayed treatment. This could be due to a lack of understanding from ED clinicians and/or poor communication between ED and the renal department. Therefore, a local clinical pathway was developed to optimise peritonitis patient care. Aims To evaluate the effectiveness of a local peritonitis clinical pathway designed to reduce time for patients with PD-related peritonitis receiving their first antibiotic treatment. Setting All patients with PD peritonitis presenting through a tertiary hospital ED. Main outcome measured Time for patients with PD-related peritonitis receiving their first antibiotic treatment in hospital. Results The average time for peritonitis treatment decreased from 6 hours and 49 minutes to 5 hours and 18 minutes after the clinical pathway was implemented. Currently there is no published data to benchmark our result, even though the results indicated that the local clinical pathway may have been effective. Implications for clinical practice Since the implementation of this project, three patients were able to be safely discharged from ED without needing hospital admission and this is due to prompt management and good communication between ED and the renal department. Delayed treatment not only causes increased demand in ED service, but also results in unnecessary hospital admission, which impacts on both the patient and the overall health care system.