A nurse-led approach to personalised, coordinated, multidisciplinary care in new haemodialysis patients Royal Liverpool and Broadgreen University Hospitals NHS Trust

Chronic kidney disease (CKD) is a life-limiting condition with a prognosis that can be worse than some common cancers. Patients with end-stage kidney disease are treated with renal replacement therapy (RRT), which includes haemodialysis at home or in hospital, peritoneal dialysis at home, or kidney transplantation.

In the UK over 7,000 patients start RRT each year, with around two-thirds starting on haemodialysis. Commencing haemodialysis is a time of significant risk and patients experience high levels of physical and psychological distress.

This project implemented a new, nurse-led pathway for 93 patients commencing haemodialysis at the Trust. The primary aims were to reduce early mortality and minimise patient distress.

The pathway comprised a combination of mandatory and personalised interventions delivered over the first six sessions of dialysis. It was designed to improve communication and co-ordination of care delivered by a large, complex multi-disciplinary team.

The pathway was implemented electronically with a robust data collection and analysis process, enabling automated, real-time reporting.

Outcomes

Implementation of this pathway has:

• reduced 90-day mortality from 5.1% to 2.1%
• reduced patient distress from an average score of 4.3 (week 2) to 2.4 (Week 8)
• increased numbers of patients with a home therapy plan at 90-days (8.5% to 26%)
• reduced the average length of stay for admitted patients from 12.2 to 8.75 days.

The project was undertaken with the primary aim of improving quality and safety, but has also released significant cost-savings of around £400,000 p.a. The pathway has now been embedded into routine care at the Trust.

Contact

For further information about the project, please email Dr Asheesh Sharma, Consultant Nephrologist and Innovation Lead for Directorate of Nephrology, The Royal Liverpool and Broadgreen University Hospitals NHS Trust.