1. VA Dataset National Kidney Care Audit

2. The audit measures two distinct areas: 1. Patient Transport Aim: To make visible the variation of provision and performance of patient transport services and to develop and communicate best practice guidelines to all those providing the service 2. Vascular Access Aim: To provide visibility of current performance and to encourage the adoption of best practice, and so improve performance to meet national guidelines National Kidney Care Audit

3. Patient Transport Audit Scope: The Patient Transport survey was designed to make visible the variation of provision and performance of Patient Transport services and to develop and communicate best practice guidelines to all those providing the service Audit questions: Does the proportion of patients starting haemodialysis with functioning permanent access meet the Renal Association and Vascular Society Guidelines for permanent vascular access? What are the health care associated infection (HCAI) rates associated with vascular access in the maintenance haemodialysis population and how does this compare with the national average and the best performance?

4. Patient Transport The survey was designed in two parts: 1.A patient questionnaire A questionnaire which captures patients views directly in a paper form 2.An electronic survey An electronic survey which was sent to HD unit managers and commissioners for HD services The first patient transport survey was carried out on 15 th and 16 th October 2008. The results have now been published in the 2008 NKCA Patient Transport report.

5. Audit Scope: The Vascular Access audit will provide information on the timely and appropriate surgery for permanent vascular access based on the recommendations of the standards and quality requirements stated in the National Service Framework (NSF) for Renal Services Audit questions: Does the proportion of patients starting haemodialysis with functioning permanent access meet the Renal Association and Vascular Society Guidelines for permanent vascular access? What are the health care associated infection (HCAI) rates associated with vascular access in the maintenance haemodialysis population and how does this compare with the national average and the best performance? Vascular Access

6. The following aspects of care will be measured: Outcome related Percentage of Haemodialysis patients starting with permanent access Percentage of Haemodialysis patients starting with catheter access Percentage of Haemodialysis patients starting with catheter access due to late referral (known to the renal service for less than 3 months before starting dialysis) Percentage of catheter starters who have a functioning permanent access established within three and twelve months Number of operations and other interventions (e.g. angioplasty, revision surgery) to establish first functioning permanent access Percentage of RRT patients diagnosed with HCAI, including complications relating to vascular access, e.g. line-related sepsis, endocarditis and osteomyelitis

7. Process related Number of access theatre lists per incident and prevalent RRT population by type of list, e.g. general surgery, day case clinic etc. Proportion referred before the time GFR is less than 15

8. Audit Data Flow Audit UKRRPaediatric UnitsData Validation Complication and Infection data linkage (HES and HPA) Data Processing Audit online reporting Online Analysis tool Published Annual report

9. Prevalent dataset collection

10. Incident events First Access

11. Access clinic timeline

12. Access events Top part – defines an access Bottom part – defines events associated with access

13. Events

14. Drop down events

15. What is happening now? Early Adopters 11 early adopter sites (including 1 paediatric unit) – each site at different stages of development. 2 units submitting test files to UKRR with other sites inputting required data and updating clinical systems as required Roll out A number of units registered interest to be part of the 1 st Wave roll out Communications with system suppliers continue as units register for the audit Reporting Reporting system under development to allow all submitting units to view their results online

16. How do I get involved or find out more? To register your unit to participate in the VA audit roll out, gain a copy of the PT report or just to gain further information on the audit then please contact the audit team at: kidneycare@ic.nhs.uk Further information on the work of the audit can be found on the National Kidney Care Audit website at: www.ic.nhs.uk/kidneycareaudit

17. How do I get involved or find out more? Why not discuss any queries or knowledge regarding the audit with other colleagues using the NKCA forum? Just register and away you go….. http://www.renal.org/forum/index.php

18. Key Contacts Richard Fluck VA Audit Clinical Lead Richard.fluck@nhs.net NKCA audit team kidneycare@ic.nhs.uk