{"id":8398,"date":"2020-09-25T12:38:23","date_gmt":"2020-09-25T11:38:23","guid":{"rendered":"https:\/\/www.thinkkidneys.nhs.uk\/kquip\/?page_id=8398"},"modified":"2020-09-25T12:44:22","modified_gmt":"2020-09-25T11:44:22","slug":"london-restarting-vascular-access-and-transplantation","status":"publish","type":"page","link":"https:\/\/www.thinkkidneys.nhs.uk\/kquip\/london-restarting-vascular-access-and-transplantation\/","title":{"rendered":"Restarting Vascular Access and Transplantation Safely"},"content":{"rendered":"\n<div class=\"wp-block-image\"><figure class=\"alignright size-large\"><img loading=\"lazy\" decoding=\"async\" width=\"336\" height=\"120\" src=\"https:\/\/www.thinkkidneys.nhs.uk\/kquip\/wp-content\/uploads\/sites\/5\/2020\/09\/South-London-Renal-Clinical-Alliance.png\" alt=\"\" class=\"wp-image-8368\"\/><\/figure><\/div>\n\n\n\n<h2 class=\"wp-block-heading\">Review of London kidney teams\u2019 response to COVID-19, March-June 2020<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">Summary of key themes<\/h2>\n\n\n\n<div class=\"wp-block-group has-very-light-gray-background-color has-background\"><div class=\"wp-block-group__inner-container is-layout-flow wp-block-group-is-layout-flow\">\n<ol class=\"wp-block-list\"><li>Review local and national shielding guidance, and current practice, and establish a consistent approach across London for before and after surgery<\/li><li>Continue pan-London collaborative work for both vascular access and transplantation to inform and coordinate surgery re-start, and follow through with pathway quality improvements<\/li><li>Develop opportunities for improving data sharing and analysis, particularly for vascular access waiting times management and improvement plans<\/li><li>Consider joint approach to surgical training<\/li><li>Share further information to promote consistency on patient information, advice helpline, counselling and consent<\/li><li>Make clear pan-London plans to assure the continuation of vascular access and transplant surgery during resurgence or second wave pressures<\/li><li>Develop plans for more resilient and assured vascular access service including consideration of ring-fenced cold site activity to protect capacity and flow<\/li><li>Re-start collaborative work on transplant work-up, unifying pathways, clearing backlog and think about &#8216;investigation centres&#8217;<\/li><li>Consider how to optimise swabbing of pre-emptive transplant patients<\/li><\/ol>\n<\/div><\/div>\n\n\n\n<h3 class=\"wp-block-heading\">Next steps<\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>Review local and national shielding guidance, and current practice, and establish a consistent approach across London for pre and post-surgery<\/li><li>Develop and continue with vascular access pan-London collaborative working<\/li><li>Working pan- London, standardise the deceased and living donor kidney transplant work-up pathways e.g. cardiac diagnostic tests <\/li><li>Develop the concept of mutual aid to accommodate the potential need for local plans to be curtailed again in a resurgence or a second surge.<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Summary of discussions<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>What worked well?<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>The Independent Sector provided green COVID-19\npathways, within the national contracts, which accelerated the surgical restart\nprogrammes<\/li><li>Close working between the renal networks and\nNHSE&amp;I enabled good use of the Independent Sector to restart Vascular\nAccess and Living Donor Kidney Transplant for most units in London<\/li><li>The pan-London Vascular Access collaboration has\nempowered clinicians and has been effective to share learning and to manage the\nphased restart of surgery<\/li><li>Living donor transplantation was restarted after\npatients had been surveyed and expressed a strong wish (90%) to restart<\/li><li>The renal network promoted sharing of shielding and\nsurgical protocols across units <\/li><li>The concept of mutual aid is now established<\/li><li>Home delivery of immuno-suppression medication was\nexpanded in many units<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Key challenges<\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>Closing surgical services is relatively easy,\nhowever re-opening safely is very difficult<\/li><li>Assuring equity of access has been a key challenge,\nparticularly in the living donor cohort for complex patients and for vascular\naccess patients already on dialysis <\/li><li>Re-start plans have needed higher levels of capacity\ninitially to reduce the backlog of activity <\/li><li>Waiting time data for vascular access is not yet\nrecorded in standard waiting lists (patient treatment list) format in many\ntrusts<\/li><li>The nature of satellite and in centre dialysis has\nprevented patients from meeting shielding criteria and has therefore limited\ntheir access to surgical low-risk pathways<\/li><li>Guidance on isolation and shielding was not always\nclear, leading to issues for patients with sick pay and safety at work<\/li><li>There has been a significant impact on complex\npatients and delays in the Deceased and living donor kidney transplant workup\npathway e.g. reduced access to clean\/green diagnostic facilities<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>What could we do better? <\/strong><\/h3>\n\n\n\n<ul class=\"wp-block-list\"><li>Provide more complete pan-London information on surgical capacity, demand and waiting times profiles<\/li><li>Plan to accommodate high risk patients and assure equity of access for vascular access and living and deceased donor kidney transplant patients<\/li><li>Develop a plan that enables some continuity of surgical procedures safely if there is a second wave of infection <\/li><li>Continue to work with all units in London to standardise surgical pathways<\/li><li>Follow consistent shielding guidance pan-London<\/li><li>Create better measures to assure equity of access<\/li><li>Review good practice across London units to share transplant follow-up process e.g. St George\u2019s ensure all transplant recipients are on home delivery from 90 days post-surgery in the absence of complications.<\/li><\/ul>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h2 class=\"has-text-align-center wp-block-heading\"><a href=\"https:\/\/www.thinkkidneys.nhs.uk\/kquip\/hub\/review-of-london-kidney-teams-response-to-covid-19-march-june-2020\/\">RETURN TO LONDON KIDNEY TEAMS\u2019 RESPONSE TO COVID-19<\/a><\/h2>\n\n\n\n<hr class=\"wp-block-separator\"\/>\n\n\n\n<h2 class=\"has-text-align-center wp-block-heading\"><a href=\"https:\/\/www.thinkkidneys.nhs.uk\/kquip\/shared-learning-covid-19-transplantation\/\">RETURN TO SHARED LEARNING FROM THE KIDNEY COMMUNITY ON TRANSPLANTATION DURING COVID-19<\/a><\/h2>\n","protected":false},"excerpt":{"rendered":"<p>Review of London kidney teams\u2019 response to COVID-19, March-June 2020 Summary of key themes Review local and national shielding guidance, and current practice, and establish a consistent approach across London for before and after surgery Continue pan-London collaborative work for both vascular access and transplantation to inform and coordinate surgery re-start, and follow through with pathway quality improvements Develop opportunities for improving data sharing and analysis,&#8230;<\/p>\n","protected":false},"author":130,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_topic_count_hidden":0,"_bbp_reply_count_hidden":0,"_bbp_forum_subforum_count":0,"jetpack_post_was_ever_published":false,"footnotes":""},"class_list":["post-8398","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Restarting Vascular Access and Transplantation Safely - The Kidney Quality Improvement Partnership<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" 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