P173
SPECIALIST YOUNG ADULT SUPPORT LEADS TO A SUSTAINED DECREASE IN
CLINIC NON-ATTENDANCE AND HOSPITAL ADMISSIONS
Tomlin, M1&2, Coyne, E¹, Bebb, C¹, Johnson, C2, Byrne, C¹
¹Nottingham University Hospitals NHS Trust, ²Derby Hospitals NHS Foundation Trust
Background: Young adults (aged 18-25) with Chronic Kidney Disease (CKD) have been
identified as a vulnerable group for poor treatment outcomes. This project was set up to explore
new and innovative ways to support this group at two NHS trusts. The project employs a youth
worker to provide one-to-one practical and emotional support in a wide range of health and
social areas.
Purpose: Audit data were collected to assess the impact of the project on clinic attendance rates
and levels of hospitals admissions within this patient group.
Design: Audit data were collected on an annual basis. Patients involved were young adults
(aged 18-25) living with CKD stages 3-5, who were under adult nephrology care at either of the
hospital trusts involved in the project on 31st December 2010. Baseline data were collected for
12 months prior to the project. Data have been collected for a subsequent 4 years.
Findings: Baseline data were collected on 80 patients. Year 4 data were collected on 66 patients
(7 discharged to GP, 4 transferred their care to another centre, 3 deceased). In year 4, 55% (36)
were male. 65% (43) had transitioned from the local paediatric centre. Most patients had a
functioning renal transplant (64% (42)), 17% (11) were CKD stages 3-5, 12% (8) were on
haemodialysis, 4% (3) on home haemodialysis and 3% (2) on peritoneal dialysis. The home
therapy rate was 38.5%.
Baseline data showed a population clinic non-attendance rate of 22.1%. In year 1, this reduced
to 14.3% before steadily rising to 19.2% in year 4. However, the number of missed clinic
appointments at year 4 was 85 compared to 161 at baseline. Throughout the audit period, males
had higher non-attendance rates than females.
Baseline data showed 98 hospital admissions within this group (416 bed days). This has reduced
each year with year 4 data showing 18 admissions (54 bed days). Re-admissions within 28 days
have reduced from 29 (baseline) to 3 (year 4). Admissions associated with non-concordance
with treatment in this group have fallen from 24 (89 bed days) at baseline to zero in year 4.
Financial implications: These data show a reduction in hospital admissions and missed clinic
appointments since the start of the young adult project. If the service is withdrawn then there is
a risk that missed appointments and admissions may return to levels seen at baseline.
Comparing baseline data to year 4, this would mean a increase of 76 missed appointments and
362 bed days each year. Using national tariff data of £138 per clinic appointment and a nominal
cost of £300 per bed day, this would mean a potential increase in costs of £119,088 per year. It
is also anticipated that there are further financial savings due to reductions in medical
interventions, pro-longed transplant survival and, less medication and supplies wastage.
Conclusion: Baseline data showed high levels of clinic non-attendance and avoidable hospital
admissions within this group. Subsequent data has shown that since the setup of this project,
hospital admissions rates and the number of missed clinic appointments has fallen. Admissions
linked with non-concordance have fallen for every year that the project has been operational.
These reduced admissions and improved clinic attendance have led to positive health and social
outcomes for young adults, whilst also providing financial savings to the NHS. These data
show the benefit of specialist young adult support and the sustained long-term positive impact
that the service has had on this patient group.