“adequate transport is so important to people on haemodialysis that it plays a vital role in the formation of patient views and attitudes towards dialysis. Good transport systems can improve patient attendance and shorter travel times can improve patient co-operation if the dialysis treatment frequency needs to be increased. Efficient transport facilities reduce interruption of patients’ social lives and may therefore improve quality of life”
Renal NSF Part 1
The audit benchmarks against the Renal Association’s clinical practice guidelines that recognise the importance of travel time for haemodialysis patients, and state:
“… except in remote geographical areas, the travel time to a haemodialysis facility should be less than 30 minutes or a haemodialysis facility should be located within 25 miles of the patient’s home. In inner city areas travel times over short distances may exceed 30 minutes at peak traffic flow periods during the day” …… “… haemodialysis patients who require transport should be collected from home within 30 minutes of the allotted time and be collected to return home within 30 minutes of finishing dialysis”
Renal Association Clinical Practice Guidelines on Haemodialysis 2009
The 2008 audit covered 242 separate dialysis units or satellite units leaving only 5 non-participating HD units in England, Wales and Northern Ireland – Aintree University Hospital, St George’s Hospital, Stratford-on-Avon, Whitnash - Leamington Spa and Yeovil that I hope will be joining in the exercise this October.
The 2008 data showed that overall, about 75% of people were picked up from their home within 30 minutes of the allocated time and for nearly 60% of patients the travel time to their dialysis unit is 30 minutes or less but some individuals are regularly travelling more than one hour to and from dialysis. Nearly 40% of people wait 30 minutes or more after finishing dialysis before they begin their return journey home. The patient stories speak much louder than these cold statistics and the variance across units identifies patient transport as an area where we can make real improvement.
The 2008 audit made several recommendations including:
- Clear and transparent commissioning arrangements with lines of accountability and means of monitoring performance should be agreed by commissioners, hospital trusts, dialysis units and transport providers.
- Dialysis providers should be involved in the transport service which patients use. Eligibility criteria, standards of performance and quality of service should be explicitly agreed.
- Patients should be involved in the commissioning and monitoring or transport. The audit demonstrated that patients want to contribute. Using the transport service gives them a unique insight into the process and a clear interest in driving up quality.
- All dialysis units should carry out regular audit of patient transport including discovering the views of its patients.
We know that patients travel considerable mileage – it’s been estimated at close on 40 million miles per year on the road for all haemodialysis patients. Many people are not having dialysis at their closest unit – this may be for clinical reasons but in some instances, it will result from poor planning. Patient transport for dialysis still wastes the time of many individuals receiving this modality. Excess travel is poor for health, wastes NHS resources and damages the environment. We can do better.
I hope that participation in the 2010 audit can be a driver for change and improvements in patient transport services. For more information contact the NHS Information Centre audit team at firstname.lastname@example.org