Implementing a Fast Track Living Kidney Donor Assessment Clinic

The Royal Devon and Exeter NHS Foundation Trust Transplant First KQuIP project

Quality Improvement Leads: Heather Atkins

Living kidney donor (LKD) transplantation provides the best outcomes for patients with end stage kidney disease. Donor assessment is often time consuming and can involve multiple hospital visits. Initiatives to implement single day assessment in other parts of the UK have been shown to increase LKD transplantation rates. As part of the KQuIP ‘Transplant First’ project in our region we identified a need to reduce delays in donor assessment to maximise the availability of LKD transplantation for our patients.

We aimed to create a fast track LKD clinic to combine the initial investigations and assessment into two visits.

A total of 28 potential donors proceeded to a Nephrology consultant appointment in our unit in 2019. Nine of these were assessed through the fast track LKD clinic, and the remaining 19 were worked up using the pre-existing donor assessment pathway. ​

The mean number of days from first contact to Nephrology appointment was 78 days in the fast-track clinic compared with 87 days in the conventional clinic. Total time from first contact to transplant centre referral was significantly shorter in the fast-track clinic (93 days compared with 158 days). ​

The introduction of a fast track LKD clinic in our unit has helped to reduce delays in LKD assessment and improved the availability of living donor transplantation for our patients.

Since completing the audit, the fast-track clinic pathway has become the norm overall and it works well. Donors approve of the fewer visits. We have good communication/organisation between us, the admin staff (who book the appointments) and the staff in the ultrasound department. We have a LKD/Nephrologist appointment per week reserved for LKDs. Before Covid we had improved the time from first contact to nephrology appointment to 4-6 weeks (28-42 days) and this was great.

However….

We have had some setbacks due to the introduction of EPIC – our hospital electronic system in October 2020. We weren’t able to reserve the LKD appointments for at least 18 months and that, alongside increased patient numbers as a whole, (post Covid lock downs), means that we had and still have a back log of donors waiting for an appointment. Now donors are waiting 10 weeks for their one-stop appointment (70 days from first contact). This is a huge shame and very frustrating, but we are sharing with new patient referrals for new clinic slots and the demand is high.

The impact of Covid has also caused increased waiting times for further investigations if required (for donors) i.e., echocardiograms and CPETS. This increases the time it takes to assess an LKD.

Overall the concept works and is favoured by donors, we hope to be able to catch up soon, and reduce the time it takes for them to be seen.