A national perspective of kidney disease Dr Richard Fluck RCP November 2017 1
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A national perspective of kidney disease
Dr Richard Fluck
RCP November 2017 1
Outline
• Scene setting
• The scale of the problem
• System levers to support improvement
• Improvement work
• Patient and public involvement
• Support to clinicians
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What is chronic kidney disease (CKD)?
• Chronic kidney disease (CKD) is a long-term condition where the kidneys do not work effectively. CKD does not usually cause symptoms until it reaches an advanced stage. It is usually detected at earlier stages by blood and urine tests. It may lead to end stage renal failure.
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What is acute kidney injury?
• Acute kidney injury (AKI) is a rapid deterioration of renal function, resulting in inability to maintain fluid, electrolyte and acid-base balance. It normally occurs in the context of other serious illness (e.g. sepsis) on a background of risk. In some renal failure may result.
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Renal
disease Data collection National Audits
NICE guidance
Interventions to
increase PAM
Specific support
to patients and
public
Think Kidneys
Stakeholder
engagement
CQUINSService
specifications
Commissioning
tools and
resources for
CCGs
Patient
safety alerts
PROM & PREM
reporting
Patient View
The house of care (renal)
QI
QoF
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The scale of the problemCommon, costly, harmful
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Acute Kidney Injury: An ‘intermediate’ health state
Associated with other serious illness
Important marker of illness severity
“Force multiplier” for poor outcomesbut …….
Potential to improve care
Reduce avoidable harm - death and morbidity
Reduce cost
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Key facts• Common – 500000 cases per annum in England• Harmful – 100000 associated deaths, 40000 excess• Costly – individual, financial, system
Hallan et al BMJ 2006;333;1047
Chronic kidney disease
• Three elements of risk• End stage kidney disease• Premature cardiovascular events• AKI risk
• Key facts• 10% population• Increasing risk with age• Associated with diabetes &
vascular disease• Cost > £1 billion pa in England
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Interconnected syndrome of CKD and AKI
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Firm foundationsSupport commissioners and organisational leads in driving and championing the need to improve kidney care.
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Our shared purpose: reduce harm related to AKI
• Support commissioners and organisational
leads in driving and championing the need
to improve acute kidney injury care.
• Provide clinicians and patients with the
education, information and access to and
about acute kidney injury to inform
individual care
• Establish the data flows to allow successful
audit and quality improvement
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AKI and Patient Safety Alerts
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AKI CQUIN driving improvements
CQUIN Elements: discharge summary items on AKI
• Stage of AKI; (a key aspect of AKI diagnosis)
• Evidence of medicines review having been undertaken (a key aspect of AKI treatment)
• Type of blood tests required on discharge for monitoring (a key aspect of post discharge care)
• Frequency of blood tests required on discharge for monitoring (a key aspect of post discharge care)
Data from > 29000 case notes in 2015/16
Proportion of Completed key items assessed in AKI patients’ discharge summaries by region
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H E A L T H C H E C K 2 0 1 4
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‘AKI warning stage’
Patient management
system
Alert Response
Local systems
Message
Master patient index
Other data systems
AKI Registry
RegionalNational
Research
QI
System Measurement
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Progress
Currently 123 labs have submitted some AKI alert files (123/159), 77.4%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
Total number of labs submitting
0
20
40
60
80
100
120
Number of labs submitting data by month
Between January 2016 and July 2017 (19 months):
• 1,451,209 e-alerts were reported
• 451,882 individual patients were identified as having AKI
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On the leftSupporting patients, listening to patients, patients leading
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Educating and guiding
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Skills, knowledge and confidence
The Four Levels of Patient Activation Diabetes
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Terminology – Your Health Survey
PAMPatient Activation MeasureSkills, knowledge and confidence to manageyour long term condition
PROMsPatient Reported Outcome MeasureQuality of life
GenericDisease specific
PREMPatient Reported Experience MeasureQuestions relating to their healthcare experienceAll Renal Units X 1 per year
EQ-5D-5LPOS – S Renal
Self developed
Patient Activation Measure (PAM)Clinician-support for PAM (CS-PAM)
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Patient View
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Intervention Toolkit: Can interventions improve activation for teams and patients?
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On the rightSupporting clinical teams
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S T E N O 2 m i c r o a l b u m i n u r i a & D M n e n g l j m e d 3 5 8 ; 6
“Therapeutic nihilism.” CKD: Treatable
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Detect Alert
Improving care for the individual
Respond
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Improving the systemGet the data, improve the value
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System improvementEnhancing the capability and capacity of the NHS to improve safetyPatient Safety
Collaboratives
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Collaborating and sharing
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Summary
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The chairs, co-chairs and teams of all the workstreamsin ‘Think Kidneys’
Joan RussellHead of Patient Safety
NHS Improvement
Ron CullenDirector
UK Renal Registry
Julie Slevin, Karen Thomas and the UK Renal Registry Think Kidneys team
www.linkedin.com/company/think-kidneys
www.twitter.com/ThinkKidneys
www.facebook.com/thinkkidneys
www.youtube.com/user/thinkkidneys
Acknowledgements
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