News from Northern Ireland
Contact Dr Billy Nelson, Lead Renal Clinician: firstname.lastname@example.org
May 2010 Update
Commissioning. Major changes to public service organisation continue with replacement of local Health Boards by and as yet ill defined body. Regular meetings continue between key members of the old structures, clinicians and managers, thankfully keeping good communications between Department of Health and front line services.
Haemodialysis: Capacity – Significant delays have occurred in planned expansion of two units. This has coincided with apparent levelling out of patient numbers on haemodialysis. Historically increased dialysis provision was repeatedly associated with a transient increase in numbers on dialysis. Hopefully the converse in not contributing to this situation. At present optimal patient placement is not always achieved but there is no awareness of failure in dialysis provision.
Haemolysis – Since my last report there have been no further episodes reported of dialysis associated haemolysis.
Home haemodialysis – While numbers remain small the provision of a second dedicated nurse has seen steady expansion in numbers to 25 with 6 patients given dates for training. Nephrologists have approved plans for nocturnal dialysis in response to patient demand which will be implemented on receipt of Trust governance approval.
Transplantation. Despite doubling the number of live donor transplants in the last year a significant back log remains with plans activated to further increase and improve the service. Theatre provision has proved a significant stumbling block in developments which is also relevant to implementation of non heart beating retrieval and transplantation. Provision of a retrieval service for this nationally along with improved with results have led to clinicians agreeing to commence a local programme. Shortfalls in both of these areas have been suggested as major contributors to this region currently having the longest waiting times to transplant after listing.
Acute kidney injury. Following the renal association response to the NCEPOD report which found significant shortfalls in AKI management contributing to adverse outcome, a small group of colleagues have published management recommendations which have been very positively received when circulated through GAIN the regional guidelines and audit group. A consequence has been the invitation to include an AKI management slot in the induction programme for all qualifying doctors in the region. This will over time rectify any educational shortfall across the region.
Manpower. Interviews for two nephrology consultant posts in coming weeks replacing retiring colleagues will continue the trend to a relatively youthful consultant workforce in this region with potential implications for incoming trainees.