Kidney Quality Improvement Partnership (KQuIP)

Update

Graham Lipkin Louise Wells

Co-chair of KQuIP Co-Chair KQuIP

23/03/2017 | 1

Access at Initiation of Dialysis

23/03/2017 2

Pre-emptive Transplantation Rates

30/10/2016 3

Home Dialysis: UK Renal Registry-Do we improve?

23/03/2017 4

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

45.0

B Heart B QEH Basldn Camb Chelms Colchr Covnt Derby Dudley Ipswi Leic Norwch Nottm Shrew Stevng Sthend Stoke Wolve

Why does unwarranted variation persist?

Many reasons:

Specific to each Unit-solutions can only come from those on the front line-you know your system best

Some systematic• Resource?• Leadership & leadership training• Training in QI methodology• Structure• We don’t share good practice (or learn from less good practice)

30/10/2016 5

Quality Improvement: Where to Focus?

Pre-dialysis Clinic

Peritoneal dialysis

Pre-emptive Transplant listing & Live donor Tx

AV Fistula

Home HD Shared HD

Conservative Care

30/10/2016Kidney Quality Improvement Partnership - Scottish Renal Association - Graham Lipkin 6

Progressive CKD

Failing Transplant

MPT• Dietetics • Modality choice Counselling/ PD nurse• Access nurse & surgeons• LD Transplant Coordinators

Unplanned starts?

NHSI-Clinical Productivity?

Kidney Quality Improvement Partnership (KQuIP)

KQuIP is a dynamic network of kidney health professionals, patients carers and industry …committed to developing, supporting and sharing quality improvement in kidney services…. in order to enhance outcomes and quality of life for patients with kidney disease.

Professional Society Led

Multi-Professional

You are part of KQuIP

25/11/2016 7

Design Event: Coming together to mould KQuIP

KQuIP Launched 2016 UK Kidney Week

30/10/20169

Programme Board

Work Stream Chairs Group

3 Work Streams

KOG

Faculty

KQuIP Workstreams

08/02/2017Kidney Quality Improvement Partnership 10

Projects workstream-Hugh Gallagher

Identifying existing QI projects

Developing KQuIP hub for case studies of renal QI work www.thinkkidneys.nhs.uk/kquip

Using the NHS Change Model to support QI projects

Identifying QI project resources to assist quality improvers

08/02/2017Kidney Quality Improvement Partnership 11

Measurement and Understanding workstreamKatie Fielding

Gathering existing measurement information for KQuIPHub

Identifying measurement tools appropriate for the multidisciplinary renal team

Tying this work into renal research

Supporting KQuIP National priorities with the measurement aspect for these projects

08/02/2017Kidney Quality Improvement Partnership 12

Development workstream- Dal Hothi & Richard Fluck

Developing NHS Wisdom to Lead for Innovation and Improvement

The core function of the development workstream will be to produce an infrastructure for talent management within the Renal Community, developing NHS leaders – now and for the future by focussing on:-

Patient development

Capacity & Capability: Building Leadership and QI Knowledge and Experiences

Faculty development

System improvement and leadership

08/02/2017Kidney Quality Improvement Partnership 13

KQuIP – How will it support Renal Quality Improvement?

08.06.2016KQuIP Launch Graham Lipkin & Louise Wells 14

National

• Advice to Clinical Reference Group.

• Central Registry Project management & faculty

• Online KQuIP Hub repository

• Industry coordination

Regional supporting Renal Clinical Networks

• Renal Registry/KQuIP quality improvement day

• Regional Project management support

• Peer assist

KQuIP - Driving Renal Quality Improvement

08.06.2016KQuIP Launch Graham Lipkin & Louise Wells 15

You & me

• Education & support materials (the Hub)

• Peer assist (Share-’ask a friend’)

• Support for local projects-Regional Project Managers

Graham

08/02/2017Kidney Quality Improvement Partnership – Karen Thomas 16

KQuIP Hub-Opened April 2017

Repository of Quality Improvement resources

• Education

• Leadership & Training in QI

• Case Studies

• We don’t always have to re-design the same wheel

• We really can learn from each other.

• Please feel free to contribute

08/02/2017Kidney Quality Improvement Partnership – Karen Thomas 17

KQuIP Hub

08/02/2017Kidney Quality Improvement Partnership – Karen Thomas 18

KQuiP Hub-Educational Resources

08/02/2017Kidney Quality Improvement Partnership – Karen Thomas 19

KQuIP Hub-QI Case Projects/Case Studies

08/02/2017Kidney Quality Improvement Partnership – Karen Thomas 20

How Will KQUIP Support Quality Improvement

1. Regional QI Days

2. 3 National Priority Projects

3. KQuIP Online Hub

4. Project Management Support

30/10/2016 21

3 National KQuIP Priority Projects

Improving access to kidney transplantation; Transplant First

Transplant First, developed in the West Midlands under KQuIP, beingpackaged to enable others to implement.

Improving access to home therapies for suitable patients

KQuIP working with Manchester Dialysis Group

Improving incident and prevalence rates of arteriovenous fistulae access

25/11/2016 22

+

Coordination with UK Transplant QI

National Scaling up

Transplant first:

Addressing inequality of access to renal transplantation across

the West Midlands

Kerry Tomlinson & Helen Spooner

30/10/2016

Project Structure

KQUIP

UKRRR

ODT

NICE Taking organ transplantation to 2020

LDKT 2020

•Identify data required, its source and obtain agreement to share data across the region•Agree formatting and regularity of reporting, e.g. quarterly audit and feedback of total transplant, live donor, deceased donor and pre-emptive transplant listing rates at each unit

•Identify repository for data

•Develop infrastructure for audit, review and reporting, e.g. RCA and audit of all patients starting RRTwithout a transplant list status

Data, measures and implementation (Kerry Tomlinson )

•Identify clinical standards and guidelines needed to improve access to transplant e.g. written acceptancecriteria for acceptance on kidney transplant waiting list

•Identify where documents already available and identify gaps, developing regional standards and guidelines as required

Standards and guideline (Nick Inston )

•Map the current patient pathways by renal unit across the region

•Co-design exemplar pathways with patients and clinicians in line with agreed standards and guidelines

Pathways ( Kerry Tomlinson)

•Collate information used across the region and upload to SCN website•Identify any gaps and develop further resources as required

Patient information (Helen Spooner)

•Identify training needs of all project participants, e.g. QI for unit leads and patient representatives

•Source/design, cost and deliver training

•Establish action learning sets

•Design first transplant education and audit event to share best practice, for roll-out annually thereafter

Education (Cecily Hollingworth)

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30/10/2016Kidney Quality Improvement Partnership Wmids Regional Day-Graham Lipkin | 25

KQuIP/Registry Day -

Aims• Know your outcomes-data• Decide on your Unit priority• Feel supported to embed QI in your practice• Identify your QI leads

Regional days Designed by Regional Network with KQuiP Support

• Data-bespoke Regional Registry & PHE report

• Explore barriers/solutions/What we’re good at

• Transplant First and Home Therapies Focus & AKI

• Agree QI leads (Clinical and MPT) & Project

• Support existing projects & with what’s next support

23/3/17Kidney Quality Improvement Partnership – Wmids Regional KQuIP Registry Day | 26

KQuIP Registry Regional Days-Wmids

23/3/17Kidney Quality Improvement Partnership – Wmids Regional KQuIP Registry Day | 27

KQuIP Registry Regional Days-Wmids

23/3/17Kidney Quality Improvement Partnership – Wmids Regional KQuIP Registry Day | 28

KQuIP Support - Post Regional Network

• Central Project management through Registry

• Individual Projects Management Support

• Registry metrics, training, peer assist, KQuIP Hub

23/03/17Kidney Quality Improvement Partnership Wmids Regional Day-Graham Lipkin 29

Regional KQuIP/Registry Events 2017

• Wmids

• Yorks and Humber

• East Midlands

• Manchester North West

• 2018 coming to you

30/10/2016Kidney Quality Improvement Partnership - Scottish Renal Association - Graham Lipkin 30

Training in Leadership & QI Methods - KQuIP

23/03/17Kidney Quality Improvement Partnership Wmids Regional Day-Graham Lipkin

KQuIP -National Meetings 2017Renal Association

19 – 21st June Liverpool

BRS

26-28th April Nottingham

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KQuIP welcomes you……enabling you and your team to improve quality and safety

www.thinkkidneys.nhs.uk/kquip/

Kidney Quality Improvement Partnership Wmids Regional Day-Graham Lipkin