Transcript Document

LEARNING FROM AUDIT
OF TRANSPLANT LISTING
WM Transplant Audit
Kerry Tomlinson Sep 2014
Preferred Pathway: Transplant First
Identify LD
Discuss
transplantation
and refer
Work up
Attend seminar,
work up and
assessment
eGFR<20
or 1 year
pre RRT
Pre-emptive
transplant
List
Discuss RRT
options
Preparation for
access
Create
access
RRT
Wmids Transplant Access Rates:
How do we compare?
UHNS
UHNS data
current dialysis
patients
2004 mean
Transplant incident numbers
35
30
25
Altriustic donor
Altruistic
20
ABOi
Paired
15
HLAi
LD
10
SPK
CAD
5
0
Pre-emptive rate
• 16%- could do better
• Donor audit
• 133 contacts lead to 19 donors
Stoke- time to listing
2000
1800
1600
1400
1200
1000
800
600
400
200
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39
Time to listing: Historical
• 2007-8 Median 170 days
• 2008-9 Median 0 days
• 2009-10 Median 0 days
• 2010-11 Stoke 84 Leighton 347
• 2011-12 Stoke 93 Leighton 407 (incomplete data)
Time for work up (mean days)
Stoke
Time from referral to
seminar to referral to
transplant centre
Leighton
287
563
As above for late listed
patients with no medical
problems
90
181 (n=1)
As above for late listed
patients with medical
problems or DNA
617
628
59
66
Time from referral to
transplant centre to seen at
transplant centre
Workup: we’ve come a long way since
2004!
• Referral to seeing KT: 104 days
• Awaiting tests: 159 days and rising
• Referral to UHB to seeing surgeon: 107days
• Total: 363 days
Tests in parallel
2004 159 days
2006 187 days
2009160
days to cardiac tests
140
120
100
80
60
40
20
0
0
5
10
patient number
15
20
eGFR at referral to seminar 2012
Stoke
Listed within
90 days of
RRT
19
Listed > 90
days post
RRT
8
Leighton
17
9
Approximately 50% late referral avoidable
Time to listing: Historical
• 2007-8 Median 170 days
• 2008-9 Median 0 days
• 2009-10 Median 0 days
• 2010-11 Stoke 84 Leighton 347
• 2011-12 Stoke 93 Leighton 407 (incomplete data)
• 2012-13 Stoke 0 Leighton 89 (same for 2012-now)
eGFR at referral to seminar 2012-now
All
Listed within
90 days of
RRT
18
Listed > 90
days post
RRT
7
Approximately 57% late referral avoidable
% of cyberren CKD5 patients not
displaying transplant status
60
50
40
2012
30
2103
20
10
0
PD
HD
CKD
TRANS
Unplanned starters
2010-2011 (up to October)
135 unplanned (22% known, 78% unknown)
• 14% (19) listed
86% (116) not listed
• 74% (14) listed <12
months
•
•
•
•
•
2 transferred
33 deceased
53 recovered
22 unsuitable
5 pt choice/1 DNA
• 26% (5)>12 months
• 3 - clinical reasons
• 1 - referral not received
by centre (how since
recovered function)
• 1- needed time to settle
Timeline-real life
Transplant
assessment
●
●
1st discussion
Ref trans
assess
LD & RRT
●
●
Mum comes
forward
●
●
●
Ref RRT
chat
Gastro all
clear
Echo
●
●
●
Blood group
●
RRT
counselling
decided PD
●
● ●
X match US
● ●
Ref
VNEP
Seen UHB
and listed
● ●
●
Waiting list
clinic
US abdo
●
Ref UHB
Donor
assessment
●
GFR &
split
function
LD
transplant
●
CT
● ●● ● ● ● ● ● ●
●
●
●
●
HTA and
UHB referral
●
●●
VNEP Urgent Tube Reinsertion
tube removed
insertion
J J A S O N D J F M A M J J A S O N D J F M A M J J
●=dietician ●=epo/iron
●=pharmacist
A cautionary tale…
Transplant
400
350
300
250
200
Transplant
150
100
50
0
Discussion