{"id":6417,"date":"2019-10-16T13:38:24","date_gmt":"2019-10-16T12:38:24","guid":{"rendered":"https:\/\/www.thinkkidneys.nhs.uk\/kquip\/?p=6417"},"modified":"2019-10-16T13:38:28","modified_gmt":"2019-10-16T12:38:28","slug":"transplant-first-what-are-the-common-themes-we-are-finding-from-working-with-regions","status":"publish","type":"post","link":"https:\/\/www.thinkkidneys.nhs.uk\/kquip\/blog\/transplant-first-what-are-the-common-themes-we-are-finding-from-working-with-regions\/","title":{"rendered":"Transplant First: What are the common themes we are finding from working with regions?"},"content":{"rendered":"\n

Dr Kerry Tomlinson,\nTransplant First National Project Lead<\/em><\/p>\n\n\n\n

The Kidney Quality Improvement Partnership (KQuIP) has visited most regions in England and facilitated group discussions around barriers to access to best practice transplantation. In every region there are areas of good practice, but no region has transplant listing absolutely cracked and we found several themes which keep repeating themselves. I presented these at UK Kidney Week (UKKW) 2019 but, for those of you who couldn\u2019t attend, I have summarised here. I have focussed on why transplanting and referring units may be different.<\/p>\n\n\n\n

Getting\ntogether<\/h3>\n\n\n\n

For many regions, the KQuIP events are a new and welcome opportunity to work together as a whole multi-disciplinary team (MDT). Hopefully if you are doing the Transplant First project you are continuing to find this. But tense relationships and hierarchy can creep in leaving things unsaid by some, and too much said by others. People often tell the KQuIP team something they haven\u2019t felt comfortable saying openly. For example, referring centres at times don\u2019t \u201cspeak up\u201d to the transplant unit and other MDT members do not challenge consultants. This hierarchical problem is well recognised in the NHS and not limited to transplantation but by being aware of it we can try and overcome it.<\/p>\n\n\n\n

Interactions\nand pathways<\/h3>\n\n\n\n

During process mapping and discussion, it often becomes\napparent that change needs to start further \u201cupstream\u201d in low clearance\nservices. Although this may seem obvious, in practice, a lot of work is\nfocussed downstream.<\/p>\n\n\n\n

Often referring units are working with two transplant units\nwith different requirements. There may be two step processes e.g. satellite\nunits which cause delay. Handover points often go wrong and may have simple\nsolutions. For a lot of patients there can be a surprisingly large number of\nvisits (especially for donors) and complex pathways.<\/p>\n\n\n\n

Referring and transplanting unit nephrologists,\ncardiologists etc. are treated differently. Often transplanting units want to\nrepeat assessments with their own clinicians.<\/p>\n\n\n\n

Assessment\nGuidelines<\/h3>\n\n\n\n

There were very few regions or referring\/transplanting unit\npartnerships with agreed assessment guidelines. Sometimes transplant units had\nnon-evidence based, rigid requirements e.g. CPET testing, BMI cut offs, need\nfor a dental check-up, which were described as contributing to significant\ndelays. Shifting goalposts and personal opinions mean that referring units are\nsometimes left guessing what is needed and frustrated when they are asked for\nextra tests after the patient is seen at the transplant unit. Equally, transplanting\nunits are frustrated when referring units give incomplete information. Much of\nthis could be avoided if pragmatic guidelines were agreed.<\/p>\n\n\n\n

Common\nbarrier themes: Clinical<\/h3>\n\n\n\n