GETTING IT RIGHT FIRST TIME

[Pages:25]Renal GIRFT

Live Donor Renal Transplantation Emerging Themes

Living Kidney Donor Forum

Graham Lipkin & Will McKane: GIRFT Renal Co-Leads

Getting it Right First Time (GIRFT)

A clinically led programme across 40 specialties:

Aims ? Reduce unwarranted variation, ? Improve the quality of patient outcomes

Phases ? Analytics ? Opportunities of HES linkage ? 52 Renal Unit Deep Dives & Reports* ? Regional implementation ? National Report (in preparation) ? Library for Peer Assist*

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Growth in Transplant & RRT across England

What is the best way to present rates?

Profound variation in ethnic diversity Deprivation and comorbidity

Virtuous Cycle & Opportunity to Improve LD Transplantation

+ NHSE Service Specs + RSTP + NHSBT Strategy +NHSE LTP

Data

Regional Transplant Networks

? QI - Training leadership ? MPT focus ? Peer learning ? Operational Delivery

Emerging Themes; Variation in Transplantation

Solutions are in place... somewhere

? Quality Improvement structures - support for Leaders* ? Regional Renal Clinical Networks ? Data for QI: accurate, accessible and timely ? LD Transplantation

? Access to transplant waiting list ? Access to live kidney donation (UKLDKSS)

? Emergency hospitalisation rates ? Medicines management ? Workforce*

? Outpatient-frequency and capacity ? Shared Decision Making

Data Rich ? not as good as we aspire to

UKRR NHSBT

? Good data to support assurance and QI requires:

? Culture across MPT ? Dedicated renal data manager ? Renal EPR that is fit for

purpose/Trust EPR ? Timely transfer of accurate data ? Accessibility- Dashboard

Where to focus resource?

Transplantation

CKD

Unplanned starter (Transplant focus)

Peritoneal

Advanced kidney care

clinic

Dialysis

Transplantation Conservative Care

PD catheter

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Haemodialysis

i a

AV Fistula

l

y

Pre- dialysis Live

s

Donor Transplant

i s

Pre-dialysis Deceased Donor Transplant List

Assessment Shared Decision Making

True Choice

Referral & Intervention

Preparation for RTT: pre-emptive listing & LD?

Advanced Kidney Care Clinics

? AKC clinics with enabled Clinical Leadership (medical and MDT)

? Transplant First culture ? Shared decision making embedded ? Adequate live donor coordinators ? MDT review meeting ? Data for QI - real time ? Referring/Tx centre listing Pathway

? Good communication & listing processes

? Prediction of ESRF

AKCC tariff that reflects major investment in clinical input

Missed transplant opportunityexpensive

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