Timely listing for kidney transplantation
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- Anissa Robbins
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1 Timely listing for kidney transplantation RA Clinical Directors Forum 9 th March 2012 Partha Das NHS Kidney Care Fellow
2 Kidney Transplantation
3 Deaths Patients on the waiting list Patients on dialysis Recipients of cadaveric transplants [USRDS, adapted from Wolfe et al., NEJM 1999]
4 Preemptive Transplantation [Collaborative Transplant Study courtesy of Chas Newstead]
5 Guidance We recommend that patients with progressive deterioration in renal function suitable for transplantation should be placed on the national transplant list within six months of their anticipated dialysis start date. Pre-emptive transplantation should be the treatment of choice for all suitable patients whenever a living donor is available. [Guideline 1.3A, Assessment of the potential kidney transplant recipient, RA Jan 2011]
6 Variation
7 International Live Donor Kidney Transplantation 2010 (Rate PMP) [Adapted from WHO/Global Observatory on Donation and Transplantation]
8 England Live Donor Kidney Transplantation 2010 (Rate PMP) [Atlas of Variation 2.0, Right Care NHSBT data]
9 Listing prior to start/within 2 years of start of RRT [Ravanan et al, BMJ 2010/UKRR]
10 Evidence based strategies to improve listing Dedicated multi professional clinic setting Early patient education
11 The Project
12 Aim to support renal units in identifying and overcoming barriers to timely listing for kidney transplantation
13 Timeline 6 month duration June 2011 EOI Sept 2011 Projects Start April 2012 Projects Start Individual unit start time 6 and 12 month updates
14 Participating Centres Bradford Colchester SW Transplant Centre Freeman Hospital, Newcastle WLRTC James Cook, Middlesbrough Lister MRI New Cross, Wolverhampton City Hospital, Nottingham UHB Heartlands Royal Berkshire Hospital Royal Derby Hospital Royal Shrewsbury Hospital Salford Royal Hospital Southmead Hospital Sussex Kidney Unit North Staffordshire
15 Modus Operandi Locally Led Centrally Coordinated
16
17 Common Themes [Derived from individual unit project profiles and monthly reporting, ]
18
19
20 Process and Pathways Delays in getting work-up Delays in getting specialist investigations Delays in getting results Delays in telling patients
21 Process and Pathways Aintree: MultiProfessional Team Clinic (MPT) Heartlands: electronic link to labs Lister: Timed slots for radiology and cardiology investigations QE UHB: Weekly MDT of LCC patients and co-ordinator presence in subsequent clinics SKU: Business case for dedicated TTE slots
22 Patient Engagement Lack of awareness of transplantation Sustaining involvement in work-up Coping and support
23 Patient Engagement Nottingham: New patient information leaflet Newcastle: Presentations and feedback from local KPA Patient held care plans WLRTC: Redraft of existing waiting list document Bradford : Ethnic Liason Support Officer UHB: Patient satisfaction survey LINK INTO CARE PLANNING
24 Education and Training Varying ownership of transplantation Varying attitudes/knowledge within MDTs Varying emphasis in pre-rrt patients
25 Education and Training Lister: Transplant link nurses study days Co-ordinators order investigations Monthly staff education sessions UHB: Staff knowledge questionnaire All: Transplant first
26 Data Collection Lack of local collection of quality or audit indicators Lack of a systematic method to identify patients without a transplant decision
27 Data Collection Wolverhampton: IT solution for tracking and flagging tests Bradford: prompts and process metrics WLRTC: Comprehensive CKD patient database with recorded transplant status (A, S, WU, N/A)
28
29 Quality Improvement Methodology IHI model Lean PDSA EBD
30
31 Learning and sharing E-seminars Press Releases Abstracts/Conference Presentations Internet
32 Impact and Outcomes Complete April 2012 End of project unit reporting Improvement data PROMs Presentation and publication
33 Legacy Sustainable changes to practice nationally Sharing and publicity of what works Relation with national strategies and research (eg. NHSBT LKD, QIPP, ATTOM) Improve delivery of best treatment for patients
34 Acknowledgements Beverley Matthews Chas Newstead Lisa Burnapp
35 Timely listing for kidney transplantation RA Clinical Directors Forum 9 th March 2012 Partha Das NHS Kidney Care Fellow
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