Lancashire Teaching Hospitals Renal Transplant Services Overview
Lancashire Teaching Hospitals' Renal Transplant Services led by Sr. Fiona Biggins and Dr. Aimun Ahmed serve a population of 1.6 million, with key areas of focus including living kidney donation, renal services across Lancashire and South Cumbria, quality improvement initiatives, and lean improvements in recipient work since 2014. The transplant team, consisting of dedicated medical professionals and staff, plays a crucial role in providing renal care to the region.
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Lancashire Teaching Hospitals TRANSPLANT SERVICES Sr Fiona Biggins Dr Aimun Ahmed living donor lead DR mArk brady Live Donor Coordinator clinical director Kquip meeting, warrington 31stJanuary, 2018
Renal Services across Lancashire & South Cumbria Serving 1.6 million population ~1270 RRT patients Kendal 670 Tx patients 90 Home Dx 515 in-centre Preston Burnley Main hub Preston Clifton Accrington 6 satellite units Blackburn Chorley Acute Dialysis Bay main ward
Quality Improvement Work across LTHTR Renal Services working with Baxter Since April 2017 to present Key Areas Vascular access Home Therapies Kidney Choices Live Donor/Tx workup
Living Kidney Donation LTHTR TRANSPLANT TEAM LTHTR TRANSPLANT TEAM Dr Ahmed Consultant Lead Dr Garrues Sr Fiona Biggins WTE Band 7 Sr Wendy Moore WTE Band 6 Transplant Work-up Prof Woywodt (RPH) Consultant Lead Dr Solomon & Dr Garrues (East Lancs) Sr Lyndsey Rushton WTE Band 6 Post Renal Transplant Dr Arunachalam Consultant Lead Dr Ahmed Dr Ponnusamy Dr Solomon Prof Woywodt Sr Mags Delargy 0.8 WTE Band 7 Sr Jenny Barlow WTE Band 7 Pharmacy Renal Pharmacist Zoe Thain Renal Pharmacist Simon Mann Administration Louise Dowling and Amy McNally - Doctors Anne-Marie Pearson and Sharifa Nakhuda - Nurses Nicola Williams - Pharmacy
Preston Deceased Kidney Preston Deceased Kidney Tx Tx Rates Rates 70 60 60 48 50 44 42 KA 40 SPK 30 Pre-emptive 20 25% 10 0 2014-2015 2015-2016 2016-2017 2017-01/2018
Lean Improvements In Recipient Work Lean Improvements In Recipient Work- -up. Ongoing Since 2014 Ongoing Since 2014 Electronic referral to the team. Indicate what cardiology investigations required Electronic signature for Tx related letters Spread sheet automated flags HLA results directly to Tx team, not consultant OPD appointments txt to patients. Filling all vacant and cancelled slots Named coordinator at Manchester Electronic referrals to Manchester reply with clinic appointment up.
Preston Living Kidney Donation and Preston Living Kidney Donation and Pre Pre- -emptive Rates emptive Rates 30 26 25 25 22 20 20 75% 15 LDTx Pre-emptive 35% 41% 10 16 % 5 0 2014-2015 2015-2016 2016-2017 2017-01/2018
Preston Living Donation Breakdown Preston Living Donation Breakdown 25 26 +7 20 22 +3 25 +3 Direct donation 20 +3 Paired/Pooled 15 ABOi 10 HLAi Altruistic Donors 5 Altruistic Recipient 0
LD Team strength and achievements LD Team strength and achievements One of the highest LD rates in the UK-17.7 pmp Good team effort! Generous patients and large population- 1.6 million The oldest UKD in the UK 85 years old! Reasonable infrastructure Dedicated Live donor clinic, 2 specialists, 2 LD Coordinators Live donor protocol based on evidence and guidelines Donor data base Full range of patient information, books, leaflets, DVDs Education (colleagues and patients)
Areas of improvement implemented Areas of improvement implemented Quality Improvement Work Shortens the pathway and avoid delays in referral e-Signing of letter by nurses/cross cover between doctors Nurses to book investigations Audit mean average waiting times for investigations and discuss delays with relevant directorates Audit average time for referrals to tx centre : LD 1st appt > surgery Recipient 1st appt > listed Dedicated regular appt slots for RPH pts in MRI
Quality Improvement Work New Donor Pathway Organise Isotope GfR, CXR, USS, LDTX clinic Pre-op cross match within 10 days of surgery Post op FU PRM Phone/Home visit Yes Surgical appointment at Tx Centre Referral to independent assessor Surgery completed 6 week post surgery OPA Post donation Annual Review Surgical MDT Team receive questionnaire. Appointment with SpN arranged. GP info requested All results & Med review complete Refer to Tx Surgeons Patient consents to being contacted re LD process Letter is sent to request donor details Donor All results within range. Is the patient interested in KSS? LDTX clinic attendance Medical Review Patient results acceptable CT & MAG 3 arranged questionnaire sent out SpN appointment SpN appointment template ABO, T/ T, Bloods, BP/HT, WT, ECHO, ECG. Book 24hr BP. ?Psych referral Specialist Referral if required HLAi/ABOi Await ABO & T/T No
Quality Improvement Work Recipient Pathway Surgery completed when eGfR 15 or below Surgical OPA at Tx Centre SpN collates consent, 2nd bloods. Counselling following consultation Appointment made for SpN and Tx Consultant Patient review Consultant & SpN with test results Referral of patient to SpN from consultant Patient attends SpN appointment Chase results from SpN appointment Consultant OPA appointment If required referral to specialist services Refer to Tx centre ABO, T/T, Bloods, HT, WT. Arrange ECG, ECHO, CXR. Give consent info. Inform consultant of requirement for ETT/MIBI Full examination and medical history
