No time to waste. Tailoring the model of care of a Kidney Supportive Care program to prioritise the time of those attending

Mrs Jennifer Kirby1,2, Dr Louise Purtell1,3, Professor Ann Bonner1,2,3,4,5

1Kidney Health Service, Royal Brisbane & Women’s Hospital, Brisbane, Australia, 2Social Work Department, Royal Brisbane & Women’s Hospital, Brisbane, Australia, 3School of Nursing, Queensland University of Technology, Brisbane, Australia, 4NHMRC Centre of Research Excellence in End of Life Care, Queensland University of Technology, Brisbane, Australia, 5NHMRC Chronic Kidney Disease Centre of Research Excellence, University of Queensland, Brisbane, Australia

Background: People with advanced chronic kidney disease (CKD) have complex treatment and support needs.  Kidney Supportive Care (KSC) is an integrated healthcare model for people with advanced CKD and their families/carers.  It comprises palliative care, renal and allied health professionals focusing on symptom management, quality of life, advanced care planning and psychosocial support.  Influenced by the #last1000days philosophy this project sought to maximise the usefulness of KSC and prioritise the time of those attending.

Methods: Stage one reviewed the model of care (MoC) using a retrospective review of i) data gathered from the Integrated Palliative Care Outcome Scale (IPOS) Renal questionnaire, ii) clinical visit data and iii) views of the multi-disciplinary team (MDT).  Stage two modified the MoC to offer joint appointments with 2 or more clinicians.

Results: Between February 2016 to January 2019 360 people attended KSC for one or more appointment, seeing up to 4 clinicians (nursing, medical, pharmacist and social work), spending between 1.5 to 3 hours in clinic.  15% of IPOS responses reported “more than half a day was wasted on medical appointments in the past week”, and 31% said “up to half a day was wasted”.  There was duplication of clinical information gathered, with people telling their story multiple times.

Since the change in MoC 67% of appointments were joint consultations when referral/triage indicated its appropriateness and the individual/family consented.  This is a time saving of 30-60 minutes for each appointment.

Discussion: Those attending KSC may have high symptom burden, presence of advanced disease and/or be in their final weeks/months of life.  These people, and their families, have no time to waste.  Providing joint consultation and prioritising the time of those attending can provide integrated, multidisciplinary healthcare that is useful, time effective and person-centred.  This approach could have practice implications in other healthcare settings.

Acknowledgments: Professor Brian Dolan, originator of the #last1000days campaign. http://www.last1000days.com/


Biography:

Jenny Kirby is a Senior Social Worker in Metro North Hospital Health Service (MNHHS) Renal Department.      Working within 2 MNHHS dialysis units and the Kidney Supportive Care clinic Jenny provides social work assessment and intervention with people with advanced chronic kidney disease and their families/carers.  With 12 years of experience in mental health, cancer care and chronic disease Jenny provides expertise in delivering person-centred psychosocial support in the areas of adjustment, quality of life, advanced care planning, end of life care, carer support, grief and bereavement.

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