Berkshire Kidney Unit Pre-Emptive Transplantation Data March 2020
The Berkshire Kidney Unit's pre-emptive kidney transplantation data for March 2020 includes details on transplant status at the time of starting dialysis, March 2020 transplant status of all dialysis and LCC patients, narrative insights, clinics letters, pre-emptive transplant listings, percentage of pre-emptive listings each quarter, and median/mean time to listing. The data provides information on key factors influencing kidney transplant processes and outcomes.
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Presentation Transcript
Berkshire Kidney Unit KQUIP data pre-emptive kidney transplantation March 2020
March 2020 transplant status of all dialysis and LCC patients PD HD working up Unsuitable No decision Active Suspended LCC
Narrative: Why? 1/cr plot Beliefs Education focus on dialysis Patient information Investigate before referral Non-standardised approaches Cardiology process delays Investigation/process momentum Lack of documentation
Clinic letter 'I explained that in a young person like herself a staged approach making use of all available modalities over time is usable advisable and I recommended that she starts with peritoneal dialysis.' She was referred as soon as started dialysis and is now transplanted
Numbers listed each quarter: % pre-emptive 80 70 60 50 Number listed in quarter 40 Pre-emptive listed % pre-emptive 30 20 10 0 2016 Q1 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2017 Q2 2017 Q3 2017 Q4 2018 Q1 2018 Q2 2018 Q3 2018 Q4 2019 Q1 2019 Q2 2019 Q3 2019 Q4 2020 Q1 Range 40-71% 2016 Q1 to 2017 Q3 Range 0-67% 2017 Q4 to present day
Median/mean time to listing 900 800 700 600 500 Median time to listing 400 Mean time to listing 300 200 100 0 2016 Q1 2016 Q2 2016 Q3 2016 Q4 2017 Q1 2017 Q2 2017 Q3 2017 Q4 2018 Q1 2018 Q2 2018 Q3 2018 Q4 2019 Q1 2019 Q2 2019 Q3 2019 Q4 2020 Q1 Range 2016 Q1 to 2017 Q3 Median time: 0-147 days Range 2017 Q4 to present day Median time: 0-444 days
Why? Failing transplant re-listing delays Refer eGFR <15 Despite predictable 1/cr plot order investigations but not refer Cardiology process delays No-one chasing results Transfers in from other units & not worked up Patient DNAs Medical complexity increasing Waiting times/process delays for Reading patients
Possible solutions Use reciprocal creatinine plot Transplant audits Standardise referral process Clarify investigation process prior to referral Reinvigorate RRT education Patient information Documentation Already done Tx MDT involve Reading; cardiology process reviewed
