Catalysing improvement in renal care

Since funding an intervention back in 2007 that focused on improving the primary care management of people with chronic kidney disease (CKD), which involved 130 GP practices, we’ve invested in a further ten projects. Most recently we’ve supported a project to develop a renal learning system across four adjacent CCGs in east London, which was included as a case study in the NHS Long Term Plan published earlier this year. 

Below we explore three of the projects that focused on scaling up interventions in renal care that had already been successfully tested and rolled out in one place. 

1. Tackling acute kidney injury

One project focused on the recognition and management of acute kidney injury (AKI), which is associated with around 100,000 deaths each year in the UK. Tackling AKI built on an intervention piloted at Royal Derby Hospital and ran between 2014 and 2017. 

It involved the implementation of a package of three measures across five hospitals in England: 

• an acute kidney injury electronic detection and alerting system
• an acute kidney injury care bundle covering assessment, investigation and basic management
• and an educational programme to raise awareness and knowledge of acute kidney injury in health care. 

While the project did not show a reduction in 30-day acute kidney injury mortality, which was the primary outcome measure, it did report a modest reduction in hospital length of stay (around 1 day) as well as in the duration of acute kidney injury episodes. As such it has important implications for how hospitals manage people with acute kidney injury.

2. SHAREHD

Renal failure has a major impact on quality of life and survival. Most dialysis patients spend many hours every week in hospital, but are often passive recipients of their care, engaging little with their own treatment.

A project led by Sheffield Teaching Hospitals NHS Foundation Trust wanted to introduce shared haemodialysis care. This is when people using dialysis units are supported to be involved in their own treatment. Patients receive training and support that is tailored according to the extent to which they want to be involved in their care. 

SHAREHD is underpinned by evidence showing that engaging people in their own care helps them to feel ‘more in control’ of their health and improve health literacy. Low health literacy among dialysis patients is associated with worse survival. 

Set up in 2016 and based on an earlier programme in Yorkshire and Humber, SHAREHD aimed to spread the shared care approach to a further 12 dialysis units across England. Over 2,000 people receiving haemodialysis are estimated to have been offered shared care as a result of this work. 

3.    ASSIST CKD

Late presentation for renal replacement therapy remains an important cause of avoidable harm and premature death. ASSIST CKD, which is led by Kidney Research UK, aims to enable the early identification of people with deteriorating kidney function and reduce the incidence of late presentation for dialysis. It uses surveillance software to produce graphs for people with low eGFR (kidney function) which are then forwarded to people’s GPs for action along with supporting guidance. 

Building on a long running project at Heart of England NHS Foundation Trust (now University Hospitals Birmingham NHS Foundation Trust), ASSIST CKD was launched in 2016 and has been implemented at over 20 laboratories across the UK. The findings of a quantitative evaluation of the impact of the project are due in 2020.

How best to share the learning?

Many of the projects we’ve funded have had a significant and sustained impact and some, like those highlighted above, have spread well beyond the places where they were first implemented. But it hasn’t always proved easy to extract and share the insights from these interventions, so that other teams across the country can learn from what worked well, and, just as importantly, what didn’t.

As with many health care specialties and settings, a big challenge for the renal improvement community has been how to ensure that teams aren’t spending time simply ‘reinventing the wheel’, or repeating mistakes made elsewhere, because they’re not aware of what others have done. 

To help address this challenge, the Health Foundation gave a small amount of money to help set up the national Kidney Quality Improvement Partnership (KQUIP) a few years ago. KQUIP, which brings together all the key agencies with an interest in renal care improvement, was launched with a mandate to develop, support and disseminate improvement knowledge and skills. Elsewhere, Q members with a background in renal care have set up a Renal Special Interest Group to share ideas and learning. 

New report coming soon

In a bid to share their learning, the teams behind the SHAREHD, Assist CKD and Tackling AKI projects have also come together this year to produce a report that captures their experiences of leading complex, large scale programmes, with recommendations for others thinking of getting involved in improvement. 

They are due to publish their main report and other outputs later in 2019. If you work in renal care, or any other field, and want to be kept informed about plans for the launch please do get in touch with us (bryan.jones@health.org.uk). 

Funding and other opportunities coming up…

There are funding and fellowship opportunities across our work to bring about better health and health care still to come in 2019:

• We are looking for outstanding leaders in health and health care policy and innovation from across Europe to join the Sciana network. Opens August 2019
• The Evidence into Practice programme is designed to help research teams bridge the gap from academic research findings, to actionable information for people practising in the field. Opens October 2019.
• Q is an initiative connecting people who have improvement expertise across the UK. Open throughout 2019.
• Working with the Local Government Association we will be launching a funding programme focused on local partnerships taking action on the wider determinants of health. Opens late 2019. 

This content originally featured in our email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.