Development of an Integrated Renal Service for North Eastern Health Board

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Development of an Integrated Renal Service for
North Eastern Health Board

• Dr John Harty
• Consultant Nephrologist
• Daisy Hill Hospital

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The Renal Service

• The Southern Board service
• The current NEHB service
• The future.

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Management of Renal Disease
General Renal Problems
Pre - Dialysis Patients
DIALYSIS (Haemodialysis / PD)
TRANSPLANTATION
DEATH
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Annual increase in ESRD patients - NI
Total ESRD patients pmp
GROWTH RATE OF 5 PER ANNUM
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Development of the Renal Service

• 1995 DHSS Review led to 1996 Renal Service
  Implementation Plan.
• Newry HD Unit opened 1.6.98
• Consultant appointed 1.8.98 with development of
  fully integrated renal service.
• April 1999, development of cross-border HD service

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ESRD therapy in Southern Board
40
52
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Evolution of HD service
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Daisy Hill HD unit statistics

• 50,000 haemodialysis treatments.
• 2000 treatments on NEHB patients.
• Growth rate of 11 in period July-02 to July 03
• 22 stations now operational.
• Maximum capacity for 90 patients

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Anticipate demand !

• Population of 302,600
• Assume 52 Tx, 40 HD and 8 PD
• Maximal prevalance of ESRD at 1000 p.m.p
• Maximal capacity of DHH unit 90 patients

121
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Acute Haemodialysis Service
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Fate of patients requiring emergency dialysis
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Peritoneal Dialysis Status
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Transplant Patients
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General NephrologyOutpatient Visits
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Nephrology at Daisy Hill
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The North Eastern Heath Board Renal Service at
Daisy Hill
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Why ?
Our key concern has been the welfare and
convenience of patients. We believe that this
is the only basis on which development should
be planned.
The Hayes Report. Page 107
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Development of the Renal Service

• 1995 DHSS Review led to 1996 Renal Service
  Implementation Plan.
• Newry HD Unit opened 1.6.98
• Consultant appointed 1.8.98 with development of
  fully integrated renal service.
• April 1999, development of cross-border HD service

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Cost of NEHB Renal Service

• Dialysis session/patient - 184.50. At 3
  session/week 553.5
• Currently 5 NEHB patients. Total 2767.5
• Outpatient session 82

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Referring Hospitals
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Quality service for N.Louth patients

• Multidisciplinary approach - on - site Consultant
  and Staff Grade
• Significant improvement in quality of life.
• 100 attainment of Renal Association Standards
  for
• Toxin Removal
• Correction of anaemia
• Blood pressure control
• Phosphate control

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What does the service provide ?

• Haemodialysis treatment
• Weekly audit
• Formal monthly clinical review
• Drug prescription - EPO, Iron, TPN
• In patient care for acute episodes
• Liaison with Nephrology service at Dublin
  Hospitals re transplantation, access.

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Comprehensive Renal Service
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Comprehensive Renal Service
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Comprehensive Renal Service
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Comprehensive Renal Service
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Predicted NEHB capacity
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60
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Renal failure in N.Louth

• Assuming a prevalence of 700 pmp 45 patients
  would benefit from HD therapy. This equates to 8
  HD stations
• If prevalence is 1000 pmp, 60 patients would
  require HD. This equates to 10 HD stations.
• Beware of underestimating demand !

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Service developments - 1

• Expansion of Haemodialysis and Peritoneal
  dialysis service for Louth patients.
• Establish a satelite facility at Dundalk
• Experienced and dedicated team.
• Excellent track record
• Established and supportive links with Nephrology
  units in Dublin and Belfast.

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Service developments - 2

• Renal outpatient services centred at Louth
  Hospital
• General Nephrology
• Chronic renal failure patients
• Transplant follow-up
• Home (Peritoneal) dialysis
• GP education service to identify and facilitate
  early referral of renal failure patients

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Service developments - 3

• In patient renal service at Daisy Hill
• Acute admissions from HD pool
• Acute renal failure service
• General Nephrology investigation service

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Why support this project ?

• Convenient location
• Local economies of scale and a critical mass.
• Sustainable clinical rota arrangements.
• Established track record in managing this service.

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Why not establish a satellite unit ?

• Increasingly frail dialysis population.
• Advanced co-morbidity with frequent complex and
  prolonged hospital admissions.
• Little capacity to accommodate such patients at
  central units during crisis events.
• Lack of comprehensive medical cover.

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Where do we go from here ?

• Consensus that this is the preferred project.
• Establish a project group with a steering
  committee.
• Define the existing and projected need.
• Cost the project
• Overcome obstacles - funding, remuneration,
  public acceptance, professional accreditation and
  insurance.
• Propose