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RAPID REDUCTION IN KIDNEY TRANSPLANT RECIPIENT WORK UP TIME BY
THE USE OF QUALITY IMPROVEMENT METHODOLOGY
Baguley, K, Barron, G, Amos, S, Robinson, H, Wood, G, Donne, R
Department of Renal Medicine, Salford Royal NHS Foundation Trust, Manchester
PURPOSE: To streamline the assessment of potential kidney transplant recipients
BACKGROUND: A pre-emptive, live donor kidney transplant is the best treatment for
CKD stage 5 in suitable patients. The assessment of potential recipients can be lengthy,
resulting in missed opportunities or delays in transplantation. Audit data from our centre
showed considerable variation and unacceptable delays in the time taken for patients to
complete transplant recipient work-up. Our centre has an excellent reputation for the use of
quality improvement techniques to improve patient care. As part of the NHS Kidney Care
“Timely listing for Transplant” initiative, we used “Quality Improvement (QI)”
methodologies to study, streamline and improve the transplant listing pathway.
METHODS: Stakeholder meetings, process mapping and PDSA cycles were used to identify
delays and redesign the recipient workup pathway for predialysis patients. The transplant
work-up protocol was revised in collaboration with cardiology colleagues. Key points along
the pathway were defined, measured and plotted on run charts to identify breakthroughs in the
improvement process as well as identify further areas for improvement.
A one-stop
transplant assessment clinic was set up to allow patients to have education and investigations
on the same day. A database was used to track patients’ progress and collate results of
investigations.
RESULTS: The time taken to complete transplant work-up reduced substantially to less than
30 days for non-diabetic patients age < 60. For more complex patients requiring cardiac
stress tests, workup is usually completed in less than 60 days. Patients requiring more
detailed cardiac assessment now benefit from a streamlined service resulting from working
collaboratively with the cardiologists to minimize delays.
Figure: Duration of transplant work-up (days)
First patient to attend one-stop
clinic
Consecutive predialysis patients referred for transplant workup
CONCLUSION: We have streamlined the transplant recipient pathway by the use of quality
improvement methodologies, achieving a marked reduction in the time taken to complete
recipient assessment. The “one-stop” clinic has allowed non-complex patients to complete
their assessment within 30 days and most others within 60 days, maximizing their chances of
pre-emptive transplantation.