5 4 Improving access to kidney transplants Kidney patients at the RFL are benefitting from a new programme which aims to help them lose weight prior to transplant. Known as Kidney Fitness for Transplant (K-FiT), the initiative focuses on improving the length and quality of life for patients living with obesity who have end-stage kidney disease. Due to the increased risks of surgery when overweight, patients must have a body mass index (BMI) of below 35 and moderate abdominal obesity to be considered for the national kidney transplant waiting list. The aim is to support patients to overcome the barrier of weight loss, so they fulfil the criteria to be listed. A team made up of dietitians, physiotherapists, psychologists, pharmacists, and a kidney transplant surgeon are working together to initially support approximately 40 patients over a year. Barnet has one of the largest and fastest ageing populations in London. Over 58,000 people are aged 65 or older, and this is expected to grow by around a quarter in the next 10 years. This presents a particular set of challenges; people living longer means that they need more care and support later in life, and access to mental health support and urgent and emergency care is vital. “Improving the care we provide to our older patients really is everybody’s business,” said David Levy, clinical lead for elderly medicine. “We have 11 medical wards, eight of which are geriatric wards, and we have 23 geriatricians which is one of the biggest specialties in medicine in the trust,” he said. For elderly patients, spending a long time in hospital can lead to an increased risk of falling, sleep deprivation, catching infections and sometimes mental and physical deconditioning. Clinical and non-clinical teams leading urgent and emergency care at BH are in the process of transforming the way in which adult and paediatric patient care is delivered. The aim is to ensure intervention happens at the right time and place to allow specialists, where appropriate, to assess, diagnose and treat patients on the same day of arrival, instead of admitting them to hospital. To do this we are focussing on the following: Opening of BH’s urgent and emergency care new front door. This space will provide a modern and spacious environment for staff and patients and will house triage, urgent treatment, and same day emergency care (SDEC) services. This is due to be completed this summer. Developing SDEC services, with the aim of delivering the same benefits as inpatient care. Expanding partnerships with external stakeholders to create a fully integrated urgent care offer for patients, in particular virtual ward services. We are working with other local trusts to design and expand this so we can deliver safe care beyond our hospital wards. After six months, most patients will either be listed on the kidney transplant waiting list, offered the opportunity to continue with the K-FiT programme, or provided with a fast referral for weight loss surgery. Jacqueline Gandy, specialist chronic kidney disease dietitian, said: “Individuals living with kidney disease often need to follow strict dietary restrictions and attempting significant weight loss can also add to the challenge of managing their lifestyle. My role involves empowering individuals to enhance their knowledge, confidence, and skills to make informed dietary choices, to help them achieve their health and weight management goals.” Mr Ammar Al Midani, consultant transplant and access surgeon, said: “K-FiT is not only about weight loss for our renal patients, it is about promoting longevity and overall wellbeing. “Through this innovative programme, our goal is to help patients with end-stage kidney disease, either approaching dialysis or currently undergoing it, to get listed on the national kidney transplant waiting list. Having a kidney transplant will significantly improve a patient’s quality of life and enable them to get back to their daily activities.” Over 800 patients visit our hospitals three times every week to receive dialysis – this is the process of removing excess water and toxins from the body to simulate the work of the kidney. Ageing well for years to come L-R: Sarah Afuwape, consultant health psychologist, Jacqueline Gandy, specialist chronic kidney disease dietitian, Ammar Al Midani, consultant transplant and access surgeon, Denise Cunningham, senior specialist renal pharmacist, Natasha Aruk, physiotherapist Natasha Aruk, physiotherapist involved in the K-FiT programme David Levy, consultant physician and geriatrician and clinical lead for elderly medicine The new urgent and emergency care front door will help triage patients upon entry To address this consultants and frailty clinical practice group (CPG) teams have been based at the emergency department and other points of entry to the hospital. They are quickly identifying patients who are suitable for other forms of care, whether that be virtual or ambulatory pathways, or community-based care. “Ageing well is about bringing care to the person’s locality or home where possible, as it is a much better experience for them,” David added. Dementia nurse specialists are also occupying and stimulating admitted patients on wards, while a physio-led ‘keep me mobile’ programme is getting patients out of bed to prevent deconditioning. Improving outcomes for frail patients by reducing time spent in the emergency department (see story above). The plan is to wrap a multidisciplinary team around patients at the start of their ED journey, as well as discharge planning from arrival and to offer a more holistic approach by linking into community services. Ageing well Reimagining urgent and emergency care at BH Organ failure and transplantation My role involves empowering individuals “ “ The team offer meal and exercise plans which are tailored to each patient’s needs, along with comprehensive support for their overall wellbeing. Some patients will also receive medication to support their fitness journey.
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