10:15 – 10:30 What’s happened since we last met? [Dr Steve Dickinson – Royal Cornwall Hospital, Truro]
• What we presented at UKKW • Summary • Data • UKKW highlight- patient (staff) information • Opt Out Law • (all these slides are available for anyone)
What did we need to do…? • Each unit to identify at least two QI leads • People needed to get to know each other • Units needed to understand how each other work • All units needed to involve and listen to patients’ views • Referring units needed to understand Bristol and Plymouth perspectives • Bristol and Plymouth needed to understand units’ perspectives • Then need to agree on common and achievable goals, as well as allowing / supporting units to improve aspects within
What have we done…? • Each unit to identify at least two QI leads • People needed to get to know each other • Units needed to understand how each other work • All units needed to involve and listen to patients’ views • Referring units needed to understand Bristol and Plymouth perspectives • Bristol and Plymouth needed to understand units’ perspectives • Then need to agree on common and achievable goals, as well as allowing / supporting units to improve aspects within
Existing data
Living donor Kidney transplant rates (pmp) idence Transplants (living) kidney living donor transplant rates Low rate (8.8-<12.7 pmp) Low-Medium rate (12.7-<15.5 pmp) Medium-High rate (15.5-<16.5 pmp) 15.5 High rate (16.5-41.6 pmp) 21.4 41.6 12.1 15.8 8.8 13.9 16.5 14.1 15.9 17.6 12.7 11.5 2016/17 Source: Annual Report on Kidney Transplantation 2017/18, NHS Blood and Transplant Source: Annual Report Kidney Transplantation 2014/15, NHS Blood and Transplant
Deceased donors
Patients active on the Transplants waiting list pmp (deceased) pmp Registrations Transplants (deceased) Kidney deceased donor Kidney registration rates transplant rates kidney registration rates kidney deceased donor transplant rates Low rate Low rate (32.2 - <41.9 pmp) (21.5 - <33.8 pmp) Low rate (32.20-<41.90 pmp) Low rate (21.5-<33.8 pmp) Low-Medium rate Low-Medium rate (41.9 - <44.1 pmp) (33.8 - <36.0 pmp) Low-Medium rate (41.90-<44.10 pmp) Low-Medium rate (33.8-<36 pmp) Medium-High rate Medium-High rate (44.1 - <46.2 pmp) (36.0 - <38.1 pmp) Medium-High rate (44.10-<46.20 pmp) Medium-High rate (36-<38.1 pmp) High rate High rate 56.5 38.5 (46.2 - 71.2 pmp) (38.1- 45.3 pmp) High rate (46.20-71.20 pmp) High rate (38.1-45.3 pmp) 42.4 26.1 40.3 36.0 56.5 35.7 45.6 38.1 46.2 37.3 41.9 38.1 41.5 22.2 44.5 33.8 71.2 45.3 44.1 42.8 32.2 21.5 43.1 35.1 Source: Annual Report on Kidney Transplantation 2017/18, NHS Blood and Transplant Source: Annual Report Kidney Transplantation 2014/15, NHS Blood and Transplant
So, we’re actually doing ok then… Yes, But…
Kidney Quality Improvement Partnership | 6/26/2019 10 West Midlands Regional Day
Kidney Quality Improvement Partnership | 6/26/2019 11 West Midlands Regional Day
Blood Group • All units agreed early potential donors faced some problems finding out what blood group they are… • suggestions….?
Where are we now? South West Team Transplant ‘ As many people transplanted with as short a wait as possible with the best experience ’ ‘More transplants, faster’
South West Team Transplant
Through discussion common priorities appeared. • Need to reduce work up times…18 weeks from start, and need to start to collect this data rigorously (with aim to reduce time) • Increase theatre availability for live kidney transplants eg Bristol negotiated a weekly theatre slot. 33 live transplants in 2018/19. • Systematically review patients with eGFR <20 • Standard protocol for referral to Transplant Assessment Clinic- Bristol & Plymouth history
What do we still need to do …? • Measure the same data to allow comparison and then allow problem solving – Time from first enquiry to ‘ready to transplant’ – Numbers of transplants
Transplant First measurement tool https://transplantfirst.renalreg.org/
What do we still need to do …? • Raise the profile of transplantation and donation locally and regionally • Focus on patients with eGFR<20- look to have a decision/ discussion for/with every patient • Local strategies for involving patients in the pathway more, and learning from recipient and donor experience
Targets • Living donation rates of … • % achieving 18 week pathway … • % of patients with eGFR <20 with decision about transplantation status…
Challenges ahead • Maintain enthusiasm across the region and locally • Finalise agreement of measurement tools and targets – find (?new) time to collect and analyse the data • External pressures • Make an impact
UKKW highlights for us
UKKW highlights for us
UKKW highlights for us
Opt out law • Organ donor law change named after Max and Keira • Max and Keira’s Law • England, Spring 2020
Keira – the donor
Max- the recipient
DBD sequential plot - Jan 2016 - Dec 2018 Welsh consent rate greater Standardised test statistic than English consent rate English consent rate greater than Welsh consent rate Number of DBD approaches
ODR • 36 % population on ODR • 46% of population of Cornwall on ODR We had a number of different approaches: • We gave talks to different WI groups and to the Cornish WI conference • We went to Young Farmers meetings • We go to the Royal Cornwall Show every year • We give talks at Truro and Penwith Colleges • We engaged with Cornwall Hospice and their project to promote end of life wishes documents • We go to park runs around the county, • Cake stalls at the main entrance • I swam round the Scilly Isles and had a stall promoting organs donation on the beach • We have a sculpture on the wall • We have a memorial garden planted in Victoria Park in Truro (waiting for a plaque before an opening event)
Project phase Monthly support visits to units offered from KQuIP 11 th April 2019 • Agree a project plan - Co-design outcomes and measures • Launch project - Co-design methods Launch event • Quality improvement and tools 11 th June • Measurement / Life QI 2019 • Project Model and NHS Change Model Introduction • PDSA to QI 1 day • Reflection on progress and overcoming challenges 24 th • Peer assist (informal learning) September • Sign posting to tools and information Sharing and 2019 learning • Sustainability 1 day • Review of progress December • Sustainability Maintaining 2019 momentum 1 day Measure Share learning Collaborate Peer assist P-D-S-A 30 Kidney Quality Improvement Partnership | South West
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