The evaluation of any national quality improvement programme has always proved difficult as it’s challenging to separate out what was emergent change that would have happened anyway, compared to the improvements that were a direct result of the programme. This requires using improvement science techniques based on trials methodologies. It is doubly difficult when the programme had an evolving nature to meet the demands of the initial research. So where do you start?
As with all national programmes a brief was provided by the Department of Health regarding their expectations on their investment. This was primarily around the establishment and embedding of AKI alerts via a national algorithm and the establishment of a registry of AKI patients. This has been largely achieved with The National Patient Safety Alert standardising the algorithm for AKI and the establishment of the Acute Kidney Injury Master Patient Index (MPI). We currently have over 400,000 patients on the MPI with 73% of laboratories reporting data, with many more having implemented the algorithm. We are already able to do some simple analyses such as
- Age profile of patients with AKI
- 30-day mortality by AKI warning stage
- AKI rates by CCG
Recent information governance permissions will allow us to link to HES data so that we can build a more comprehensive picture of AKI within England. So, on those simple criteria the programme has met its original aims, but it has also achieved much more.
The programme has significantly influenced policy through two national Patient Safety Alerts, and the implementation of a national CQuIN which demonstrated an impact during the year it was implemented. The second Patient Safety Alert identified and pointed people to the large number of resources that have been produced and which will need to be maintained. This is achieved by the ongoing commitment to the Think Kidneys brand and website. The Think Kidneys website has a wealth of resources that have been well used by the NHS, as demonstrated by the case studies on the site and the number of hits and comments to the questionnaire used to evaluate the programme. The website provides easy access to educational resources and other materials developed by the programme, for both patients and professionals.
One of the highlights of the programme was the award winning public campaign which, when the programme was established was not even on the radar of the team. However, an Ipsos -Mori poll soon made us all realise people were just not aware of what their kidneys did, or more importantly, how to keep them healthy.. The campaign had incredible reach and developed resources that are still available to raise awareness of the importance of kidneys and shaped the name of the programme and the call to action it symbolises.
So what of the future? Will improvements be maintained and will the work continue? The answer is yes – the existence of the MPI now means we will be able to measure the ongoing development and variation that may exist nationally. We can continue build the clinical and economic case for the early and appropriate treatment of patients with AKI. There is however a danger and we must ensure we pass the baton over to other areas of the NHS to implement the required changes locally while maintaining a national steer. I hope the call to action that Think kidneys gives us will remain a focal point for both the public and healthcare professionals.
Ron Cullen
Ron is Director of the UK Renal Registry and has more than 30 years’ experience working in the NHS, starting his career after his degree at Aberystwyth University as a biomedical scientist. Ron then went on to work in the fields of governance and quality improvement with senior roles in these areas including Director of the National Clinical Governance Support Team and Head of Healthcare Quality and Standards within the Department of Health. Ron has lectured and presented on quality improvement across the globe.
When he’s not working, Ron likes spending time with his family and is a bit of a Rugby nut – he coaches an under 16 Rugby team and says ‘it’s the best game in the world’.
Ron can be contacted at Ron.Cullen@renalregistry.nhs.uk