Whats happened since we last met? [Dr Steve Dickinson Royal Cornwall - - PowerPoint PPT Presentation

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

Source: Annual Report Kidney Transplantation 2014/15, NHS Blood and Transplant Source: Annual Report on Kidney Transplantation 2017/18, NHS Blood and Transplant

Transplants (living)

21.4 15.8 16.5 15.5 41.6 12.1 8.8 13.9 14.1 15.9 12.7 17.6 11.5

idence

2016/17

Living donor Kidney transplant rates (pmp)

Deceased donors

kidney deceased donor transplant rates Low rate (21.5-<33.8 pmp) Low-Medium rate (33.8-<36 pmp) Medium-High rate (36-<38.1 pmp) High rate (38.1-45.3 pmp)

26.1 38.1 22.2 38.5 36.0 35.7 37.3 38.1 33.8 45.3 21.5 42.8 35.1

kidney registration rates Low rate (32.20-<41.90 pmp) Low-Medium rate (41.90-<44.10 pmp) Medium-High rate (44.10-<46.20 pmp) High rate (46.20-71.20 pmp)

42.4 45.6 41.5 56.5 40.3 56.5 46.2 41.9 44.5 71.2 32.2 44.1 43.1

Low-Medium rate (41.9 - <44.1 pmp) Low rate (32.2 - <41.9 pmp) Medium-High rate (44.1 - <46.2 pmp) High rate (46.2 - 71.2 pmp) Kidney registration rates Kidney deceased donor transplant rates Low-Medium rate (33.8 - <36.0 pmp) Low rate (21.5 - <33.8 pmp) Medium-High rate (36.0 - <38.1 pmp) High rate (38.1- 45.3 pmp)

Registrations Transplants (deceased)

Source: Annual Report Kidney Transplantation 2014/15, NHS Blood and Transplant Source: Annual Report on Kidney Transplantation 2017/18, NHS Blood and Transplant

Patients active on the waiting list pmp Transplants (deceased) pmp

So, we’re actually doing ok then…

Yes, But…

6/26/2019 Kidney Quality Improvement Partnership | West Midlands Regional Day 10

6/26/2019 Kidney Quality Improvement Partnership | West Midlands Regional Day 11

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

Number of DBD approaches Standardised test statistic Welsh consent rate greater than English consent rate English consent rate greater than Welsh consent rate

DBD sequential plot - Jan 2016 - Dec 2018

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
• pening event)

30

Kidney Quality Improvement Partnership | South West

Project phase

Launch event

• Agree a project plan
• Co-design outcomes and measures
• Launch project
• Co-design methods

Introduction to QI 1 day

• Quality improvement and tools
• Measurement / Life QI
• Project Model and NHS Change Model
• PDSA

Sharing and learning 1 day

• Reflection on progress and overcoming challenges
• Peer assist (informal learning)
• Sign posting to tools and information
• Sustainability

Maintaining momentum 1 day

• Review of progress
• Sustainability

11th April 2019 11th June 2019 24th September 2019 December 2019

P-D-S-A Measure Share learning Collaborate Peer assist

Monthly support visits to units offered from KQuIP