Summary of report from Peer Review Visit to the Edinburgh Renal Unit, November 2001
Peer reviews were introduced by the Scottish Renal Association in 2000. Multidisciplinary teams formed from other Scottish Units visit units and report to the parent Trust. The Edinburgh Unit was visited by a team consisting of two consultant nephrologists, one consultant transplant surgeon, one senior nurse, two patient representatives, and an administrative assistant from the Scottish Renal Registry. Numerical data was prepared in advance by the Scottish Renal Registry team and by the local unit. The team then spent two days viewing the Unit and interviewing patients and members of staff. Patient feedback was broadened by prior delivery and review of a questionnaire. Below are a number of messages from the report, which was generally very favourable and supportive. Inevitably we (and they) focus on areas where improvements could be made.
Some direct quotes from the team's report:
'Overall the team was very impressed by the quality of the renal service provided to Lothian and Borders patients.'
'The consultants and other members of the team are very dedicated and hardworking.'
'The Transplant Unit we believe to be a model unit for what the future transplant unit should be ..... The accommodation is antiquated but the impression that any visitor gets is of an extremely happy Unit with an enthusiastic workforce who all seem to be able to pull together as a team and enjoy their work.'
'As a patient, would I be happy to attend Edinburgh Royal Infirmary Renal Unit? Answer, yes, by all means.'
Comments on particular areas, and responses
The visitors were thorough and we think gained a fair impression of the service in Edinburgh. We are grateful for their work. We believe that we have an impressive service though we are aware of areas that we would like to improve.
Medical staffing. A shortage of medical consultant staff was highlighted repeatedly. Levels of junior medical staffing were however felt to be generous in comparison with other units.
RESPONSE: We believe that there is a strong case for two new consultant appointments and will continue to press for these. Junior medical staffing is primarily dictated by ability to provide training whilst keeping working hours within acceptable limits this is likely to be re-examined closely in the near future.
Radiological support was felt to be excellent.
Dietetic service excellent, but there had been an inadequate increase in staff with increasing workload.
Social work - a first rate service.
Clerical and secretarial services major problems with understaffing here.
RESPONSE: We agree with the comments about our Radiological, Dietetic, and Social Work services, and acknowledge the problems with clerical and secretarial services identified by the visitors. We would dearly like to improve these latter.
Haemodialysis ageing machines with an inadequate mechanism for programmed replacement. A high rate of tunnelled central venous access devices was noted, with potential to improve the rate of permanent subcutaneous access. It was speculated that this, and limited ability to extend dialysis hours, contributed to a lower rate of achieving dialysis 'dose' targets than in some other Scottish units. There were serious problems with transport arrangements for regular patients.
Anaemia managment major improvements following increased funding for erythropoietin and appointment of a nurse practitioner but further work still required to meet national targets.
RESPONSE: We are continuing to improve anaemia management, and our internal and external audits show a remarkable rate of improvement from a low baseline that was largely attributable to previous local funding problems for recombinant erythropoietin.
Wards too much time had to be spent by junior medical staff managing bed shortages and trying to find X-rays.
RESPONSE: Radiology film distribution is at a critical level of disarray at the Royal Infirmary. Realistically this is only likely to be solved by the introduction of electronic image transmission, PACS, which it is hoped will be available when we move to the New Royal Infirmary in 2003.
Bed availability is an unacceptable problem but one that has been with us for a long time. The Trust is attempting to address it and we continue to hope for greater success.
Management structure it was suspected that this disadvantaged renal services.
Expansion plans there was concern that planning
for predictable future expansion was behind schedule.
From EdREN, the website of the Renal Unit at the Royal Infirmary of Edinburgh, Scotland, UK. This page created August 2002. Contact us with comments at Renal@ed.ac.uk