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Renal Transport Project Wales
Dialysis Transport…the beginning In Wales, Renal Networks established March 2008; Original remit – Renal Replacement Therapy
including Vascular Access; Active decision to pursue Dialysis Transport – integral
part of UHD treatment Commissioning responsibility not with RRT
commissioner – disjointed.
Assessment Previous commissioning roles meant that the RNM’s
were aware of issues; Discussed with Welsh Kidney Patients Association Joint survey WKPA and WAST in early part of 2008
Outcome presented at National Annual WKPA conference and for Minister for Health & Social Services
WKPA / WAST Survey Massive variation between three regions but all
generally poor Satisfaction highest with patients on longest journeys
(the ones relying on taxi’s i.e. dedicated in al but name)
Started formal engagement between renal networks and WAST
Slow fuse between November 2008 and March 2009…
Project Start SWRN and SE Region of WAST – good working
relationships, similar approach and style… Momentum No democracy as being caught up in politics,
personalities, etc ‘Machiavellian approach’ – prepared environment,
champions, etc
Briefed Minister on option to tackle the challenge head on and a project to establish a dedicated dialysis transport service
The project Needed dedicated resource to undertake project Wanted a focus on patients rather than money,
resources Strong character required as WAST has leadership
issues locally and nationally Not sure on all the specifics but had cunning plan… Recruited Kate May
Political / Organisational Context Massive Ministerial interest in renal: double-edged
sword but adds momentum and remit in difficult environment
Structural consolidation with larger NHS organisations, mergers, and joining of primary and secondary care – no more purchaser / provider split (sort of)
Establishment of Welsh Renal Managed Clinical Network – budgetary control / Performance Management – “Specialist Commissioner”
WAST & NETWORK Its getting better
(ish)… WAST not used to dealing with creatures like network
with such focus, cohesiveness and patient / Ministerial support
Very uncomfortable at times particularly with bigger review of PTS services in Wales
Project Vision Dedicated transport service that will be patient
focused and timely. Transport will become part of the care plan for
patients receiving unit based haemodialysis Transport will be planned collaboratively with the
ambulance service, the patient and the renal unit staff to minimise delays
Patients will travel in comfortable, appropriate vehicles
Improve patient experience
Renal Standards 30:30:30 75% of patients should access their renal dialysis unit
within 30 minutes travelling time of their home 85% of patients should arrive on the dialysis unit no
earlier than 30 minutes before their dialysis start time. 85% of patients should leave the hospital no later than 30
minutes after their dialysis completion time.
Cheshire and Merseyside NHS Trust 2006
Building Key Relationships Patients WKPA Renal Unit Managers WAST Project board has representation of each of these
groups Collaborative accountability for performance
standards of the service
Exploring the options Standardise ‘Ready Times’ Geographically zoning patients Phasing appointment times Visit to existing successful services: Glasgow and Lanarkshire West Ambulance Services
Oct 2009 Yorkshire Ambulance Services – Feb 2010
Patient InvolvementQuarterly NewslettersDedicated email addressDedicated Free post addressComment cardsPatient forum events
Patient Forums 13 units in Wales Every unit visited over two days to engage with all
patients am/pm for each day. Discussion about newsletter, project plans, feedback
and questions Patient comments re current service and key points
for change. Great value placed on having the same driver
each time, pick up times, prompt pick up following treatment
Vehicle Options More suitable vehicles needed Selection of vehicles shortlisted by Fleet
department as suitable according to brief Vehicle options including potential adaption
presented to patients at five units. Two days at each unit.
Scoring sheets to offer feedback on comfort, access, space, interior layout etc
Vehicle Scoring
Individual Transport Plans Recruited dedicated renal planning staff Transport plans include:i Transport Pack - to collate patient details and
comments. Patient and unit representative to sign off details
t Transport Mask- a saved plan that is most appropriate according to the transport pack, meeting renal standards and is repeated every journey.
Patient and unit staff to agree mask
Benefits of an Individual Transport Plan
Patients involved directly Patient focused Quality focused against renal standards Same journey each time Dedicated driver or team of drivers Continuity that patients desire in terms of pick up
times, routes and fellow passengers Information sharing Improved patient experience Identifies areas where reinvestment required
A contactable Service: Dedicated Renal Unit telephone line operational since
June 2009. Prioritised queuing, operational from 6am until 7pm to
assist resolving issues daily
Dedicated Renal Patient Telephone Line operational since January 2010
Operational 6am until 8am to provide contact to resolve issues when units are not yet open
Renal Transport Coordinators National team of staff providing point of contact for renal
patient and staff Work a shift pattern to offer telephone line cover primary
hours that units are open Assist in resolving transport issues on the day Available for patient queries and concerns Reducing delays by updating drivers ready times etc Transport packs and masks Complaints and performance monitoring Is developmental Permanent posts advertised currently to replace
temporary team
Service Pilot St Woolos
Subsidiary unit with appropriate cross section of patients
Offers an opportunity to explore the benefits and associated cost of a dedicated service as a gold standard
Transport planned to meet 30:30:30 Dedicated drivers working most appropriate shift
pattern Test drive of proposed new vehicles
Performance PilotAlltwen
Newly opened subsidiary unit with a small number of patients
Allows the opportunity to explore performance monitoring options and reporting
Transport planned to meet 30:30:30 Trialling of several methods of collating
performance data
Patient Experience Patient satisfaction questionnaires pre and post pilot Questions offered on timeliness of service on specific
recent time period Questions offered relating to quality of life, using
questions from a recognised quality of life assessment tool.
Patient forums before and after service implementation
Next Step... Permanent appointment of Renal Transport Coordinator
team Feb 2010 Pilots underway 2010 Post pilot evaluation 2010 Analysis of costing and patient experience National roll out of dedicated service based on pilot
results
Regional Action Plans Individual Transport Plans
Any Questions?