It is well known that there remains considerable variation in care and outcomes across the NHS, despite evidenced based guidance. It is essential that unwarranted variation is addressed to ensure equity of treatment and efficient resources utilisation. Peer review and learning can be a helpful method to highlight different approaches to care, with learning from each other and mutual support.
An outcome based peer review was therefore performed by all specialised commissioned renal services in the seven West Midlands renal units in October 2017. In total this covers over 6000 adult patients receiving renal replacement therapy as a transplant or dialysis, plus many more approaching the need for such treatment. This was led and facilitated by the West Midlands Renal Network hosted by NHS England West Midlands.
A peer review group was established via open invitation from the expert advisory group of the West Midlands Renal Network, this was led by the Renal Clinical Director. This multi-professional group, including patient representatives, agreed on the structure for review, and data sets to be collected. Full consultation was then taken within the region with establishment of terms of reference via NHS England Specialised Commissioning. The Network then worked with Kidney Quality Improvement Partnership (KQuIP) and the UK Renal Registry (UKRR) to produce a bespoke West Midlands outcome data set from standard data already nationally submitted by units. This facilitated identification of specific areas of variation for focus. Topics identified for review were chronic kidney disease/end stage kidney disease interface, Haemodialysis, Peritoneal Dialysis, Home Haemodialysis, Transplantation (workup and follow up) and Miscellaneous to include staffing, patient feedback and transport. Agreed additional data sets were compiled by the units, along with brief presentations to include three items of which the unit was proud, three where they acknowledged further work was needed and three where advice was required. Data was compiled ahead of a ‘peer review day’ in October 2017 which was very well attended by the renal teams. Three hour workshops were then held covering each topic with regional data presentation and unit ‘three item’ presentation. Agreed themes for discussion came from these presentations. All attendees provided real time written feedback to all units and a report was compiled following the whole process as a summary of discussion and highlight of areas for regional QI focus. Each unit, and their executive team, also received an individual report of areas where peers felt specific action was required. All units shared policy and procedure documents, along with patient information leaflets, to allow peer help with development if required.
This has been a large project which needed support of the Renal Clinical Network to facilitate. Feedback from participants was very positive with agreement to perform again in two years to include learning from GIRFT. It was clear that different units achieved similarly good outcomes using different processes, and that there is no ‘one size fits all’ solution.
The Renal Clinical network ran a second event on the 17 October 2018 where all units provided updates on issues and concerns highlighted in 2017.
Full reports can be found below: