Tuesday, 6 December 2011

Turning audit into action

I recall the smiles and merriment around the room when Mr Neil Parrott (Consultant Transplant Surgeon, Central Manchester) was incorrectly down as a representative of the British Transport not Transplant Society at one of our BRS workforce meetings in 2002. Hoots of laughter – but no-one asked the question “well who is representing transport?”. The difficulty of identifying someone to own the issue of transport for dialysis has been part of the problem.

Everyone in the kidney community knows that transport for haemodialysis is always one of the top 3 concerns patients have – it’s usually first, second and third!In June 2009 the NHS Information Centre published the results of the National Kidney Care Audit which examined the quality and satisfaction of patients receiving haemodialysis for established renal failure and highlighted that although in many places journey times were reasonable, overall the system performed poorly in relation to transport pick-up and patient satisfaction. This was the first time robust national data was available. A call to action was made but results were not that much different when the audit was repeated in October 2010 and published again earlier this year.

The audit loop had not been closed; a common criticism of clinical audit. But the issue is on the kidney care networks’ agenda now and, in addition, transport for patients receiving haemodialysis is now one of the core Renal Association NHS Evidence approved clinical practice guideline audit measures.

NHS Kidney Care has developed ten specialised commissioning group report summaries which describe the 2010 survey findings and compare them with the findings from the earlier study. Kidney Care Networks, commissioners and providers should now be using the detailed data in these reports for assessing and improving the transport services they currently provide. Local kidney patient associations and groups should also be involved in the commissioning of transport services – that’s the only way to get a patient centred and patient sensitive service.

Patient transport services have also recently been subject of Parliamentary review by the Public Accounts Committee which recommended a series of actions to improve the current poor patient experience, efficiency and value for money.

Perhaps most powerfully of all, we have a NICE chronic kidney disease quality standard to help close the audit loop and improve patient experience.

Quality statement 15: patient transport
Quality statement
People with CKD receiving haemodialysis or training for home therapies who are eligible for transport, have access to an effective and efficient transport service.

Quality measure Structure:
a) Evidence of local transport arrangements to ensure that people with CKD receiving haemodialysis or training for home therapies who are eligible for transport, have access to an effective and efficient transport service.b) Evidence of local arrangements to act upon the latest patientsatisfaction results from the National Kidney Care 2010 Patient Transport Audit.

What this means for different people:

People receiving dialysis in a renal unit or hospital, or training for home therapies, who are eligible for assistance with transport can obtain efficient and reliable transport to and from the unit or hospital.

Transport service providers quality ensure they provide effective and efficient transport for people receiving haemodialysis in a renal unit or hospital or training for home therapies, who are eligible for transport.

Healthcare service providers ensure that haemodialysis treatments in a renal unit or hospital and training for home therapies take place on time so that transport schedules can be upheld.

Healthcare professionals assess people’s eligibility for transport if they are receiving haemodialysis in a renal unit or hospital or training for home therapies. They review this when circumstances change and help to ensure that haemodialysis treatments, and training for home therapies, take place on time so that transport schedules are upheld.

Commissioners commission services that provide effective and efficient transport for eligible people receiving haemodialysis in a renal unit or hospital, or training for home therapies.

The non-emergency patient transport service specification of the East Midlands Kidney Care Network has now included these measures in its tendering process. Kidney unit specific key performance indicators including arrival and collection of patients, journey times, patient satisfaction and information provision will soon be part of the regular transport review process in the East Midlands. In the three North West networks the review should link to the local haemodialysis patient eligibility exercise. It sounds like real progress but if not, the data, as well as the stories will be there for all to see, we will be able to learn lessons and try again. The national audit will be carried out again in October 2012 by NHS Kidney Care, offering an opportunity to assess progress.






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