Background In patients with multiple comorbidities, and the elderly, dialysis does not always offer a survival benefit. Even when dialysis may improve prognosis there are significant burdens to patients. Patients on dialysis spend more time in hospital and are less likely to die at home or in a hospice compared to those managed conservatively. In 2017 NHS Fife created a Renal Supportive Care Nurse (RSCN) post dedicated to the supportive care of patients with advanced renal disease (‘Renal Supportive Care Pathway’ (RSCP)).
Aims To evaluate the impact of the RSCN role on the care of people with End-Stage Renal Disease (ESRD) in Fife.
Methods Patients with ESRD were identified from the NHS Fife renal service patient administration system. Data were collected on two 40 patient cohorts who died of ESRD. Cohort A died prior to the introduction of the RSCN, and Cohort B died following the introduction of the RSCN.
Results There was no significant difference in the sex-ratio or age between Cohort A and Cohort B. Patients in Cohort B were significantly more likely to have conservative care (65% vs 3% in Cohort A), significantly more likely to have an electronic Key Information Summary (70% vs 18%), and significantly more likely to die in a community setting (73% vs 25%). The median number of tests performed on patients in their last 30 days of life was significantly lower in Cohort B (reduced by 63%).
Conclusions The RSCN and the implementation of the RSCP have had a positive impact on the care of patients with ESRD, leading to a reduction in the medicalisation of a frail population, and an increase in community-based care, including at EOL. The RSCN has also been a valued addition to the renal team in Fife and this work provides objective evidence of her impact.
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