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Scottish Haemodialysis Vascular Access Appraisal Report

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Scottish Haemodialysis Vascular Access Appraisal Report Scottish Haemodialysis Vascular Access Appraisal Report: Relating Variation in Outcomes to Variation in Processes Scottish Renal Registry In conjunction with Darlinda’s Charity for Renal Research and the University of Glasgow November 2015 Scottish Haemodialysis Vascular RenalAccess Appraisal Report Association Scottish Haemodialysis Vascular Access Appraisal Report: Relating Variation in Outcomes to Variation in Processes Scottish Renal Registry In conjunction with Darlinda’s Charity for Renal Research and the University of Glasgow November 2015 Scott W. Oliver1, Jacqueline Campbell2, David B. Kingsmore3, Ram Kasthuri4, Jamie Traynor5, Wendy Metcalfe6, Peter C. Thomson7 Email: [email protected]; [email protected] Twitter: @VAccessScotland 1 Specialty Registrar in Renal Medicine; Clinical Teaching Fellow, NHS Lanarkshire; 2 Senior Information Analyst, Information Services Division, NHS National Services Scotland 3 Consultant Vascular and Renal Transplant Surgeon, NHS Greater Glasgow & Clyde; 4 Consultant Interventional Radiologist, NHS Greater Glasgow & Clyde; 5 Technical Director, Scottish Renal Registry & Consultant Nephrologist, NHS Greater Glasgow & Clyde; 6 Chair, Scottish Renal Registry & Consultant Nephrologist, NHS Lothian; 7 Consultant Nephrologist, NHS Greater Glasgow & Clyde. ii Scottish Haemodialysis Vascular RenalAccess Appraisal Report Association CONTENTS LIST OF ACRONYMS .................................................................................................................. IV ACKNOWLEDGEMENTS ............................................................................................................. V BACKGROUND ............................................................................................................................ 1 SUMMARY AND RECOMMENDATIONS ..................................................................................... 2 Populations ......................................................................................................................................... 2 Patient Experience .............................................................................................................................. 3 Creation of Vascular Access ............................................................................................................... 3 Maintenance of Vascular Access ........................................................................................................ 5 Service Performance & Development Needs ..................................................................................... 6 INTRODUCTION .......................................................................................................................... 8 METHODS ..............................................................................................................................10 Overview ............................................................................................................................................10 The theoretical basis for a mixed-methods approach .......................................................................10 Relating systems thinking to clinical practice ....................................................................................11 Study design ......................................................................................................................................11 RESULTS POPULATIONS .....................................................................................................16 The Renal Replacement Therapy Population ....................................................................................16 The Haemodialysis Population ..........................................................................................................18 Staphylococcus Aureus Bacteraemia ................................................................................................24 Current Activity Levels .......................................................................................................................24 RESULTS QUALITATIVE DATA ANALYSIS ............................................................................27 The Patient Experience ..................................................................................................................... 29 Creation of Vascular Access ..............................................................................................................31 Maintenance of Vascular Access ...................................................................................................... 46 Service Performance & Development Needs ................................................................................... 57 MOVING FORWARD ...................................................................................................................74 Governance ........................................................................................................................................74 Job Planning ......................................................................................................................................74 SERVICE PERFORMANCE ................................................................................................................75 Education ...........................................................................................................................................75 Patient Experience .............................................................................................................................76 Processes ..........................................................................................................................................76 CONCLUSION .............................................................................................................................78 REFERENCES ........................................................................................................................... 80 APPENDIX 1 INTERVIEW SCHEDULES ................................................................................... 82 Staff Interview ................................................................................................................................... 82 Patient Interview ............................................................................................................................... 87 APPENDIX 2 INTERVIEW DETAILS ...........................................................................................91 APPENDIX 3 PROCESS DIAGRAMS FOR EACH ADULT RENAL SERVICE ........................... 92 iii Scottish Haemodialysis Vascular RenalAccess Appraisal Report Association LIST OF ACRONYMS AVF .........Arteriovenous fistula AVG ........Arteriovenous graft ARI .........Aberdeen Royal Infirmary CVC ........Central venous catheter DGRI .......Dumfries and Galloway Royal Infirmary eGFR ......Estimated glomerular filtration rate EHR ........Electronic Health Record GLAS ......Glasgow Renal and Transplant Unit HD ..........Haemodialysis MDT ........Multidisciplinary Team MONK .....Monklands Hospital NTCVC ....Non-tunnelled central venous catheter NHS ........National Health Service NINE .......Ninewells Hospital PD ..........Peritoneal Dialysis RAIG .......Raigmore Hospital RDU ........Regional Dialysis Unit RHSC ......Royal Hospital for Sick Children, Yorkhill RIE..........Royal Infirmary of Edinburgh SAB ........Staphylococcus aureus bacteraemia SIMD .......Scottish Index of Multiple Deprivation SRR ........Scottish Renal Registry TCVC ......Tunnelled central venous catheter UKRR ......UK Renal Registry UKRA ......UK Renal Association USS ........Ultrasound Scan VA ...........Vascular Access VAC ........Vascular Access Coordinator VAN ........Vascular Access Nurse VHK ........Victoria Hospital Kirkcaldy XH ..........Crosshouse Hospital iv Scottish Haemodialysis Vascular RenalAccess Appraisal Report Association ACKNOWLEDGEMENTS The authors wish to record their thanks and gratitude for the time and effort given by the 52 clinicians and patients at all 10 adult and paediatric Scottish renal units, who participated in the appraisal and assisted with logistical arrangements. The authors would also like to extend their gratitude to: Martin O’Neill, Jackie McDonald and Stephanie Lang, Scottish Renal Registry, Information Services Division, NHS National Services Scotland; Jean Thomson, Antonella Grimon, Kellie Callender and Christina Hays at NHS Greater Glasgow & Clyde, for their administrative support in producing the typed transcriptions of the recorded interviews; Leigh Bainbridge for her assistance in coordinating and formatting data during the six-week activity census; Dr Ann Humphrey, Associate Specialist Nephrologist, NHS Grampian Mr Stuart Suttie, Consultant Surgeon, NHS Tayside Darlinda’s Charity for Renal Research for their generous financial support; Professor Denis Fischbacher-Smith, Research Chair in Risk and Resilience, Adam Smith Business School, University of Glasgow; Professor Alan Jardine, Head of School of Medicine, University of Glasgow v Scottish Haemodialysis Vascular RenalAccess Appraisal Report Association BACKGROUND In 2014 the Scottish Renal Registry in conjunction with Darlinda’s Charity for Renal Research and the University of Glasgow, undertook a National Appraisal of Haemodialysis Vascular Access Services in NHS Scotland. This project attempted to understand vascular access as a whole system rather than simply
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