RenalGuard –The kidneys are nowhere

near the heart !Paul Stephenson

What’s all the fuss about ??

Harvard Business Review “Providers must lead the way in making ‘value’ the overarching goal” . – M Porter HBR Oct 2013.

where Value Based Health Care is defined as:- Outcomes that matter to a patient

Cost of DeliveryThere are two aspects for any company to solve:

FINANCIAL BENEFIT - NHS Corporate want to be able to know and see a Return on Investment (ROI)QUALITY & CLINICAL BENEFIT – As CCG’s are redesigning services due to cost pressure and austerity management – they want waste out of the budget, without a drop in quality

NICE Costing Statement (Acute Kidney Injury: prevention , detection & management of AKI up to the point of renal replacement therapy – August 2013 (CG169)

“ 3:1 – Prevention or earlier detection and treatment of AKI is expected to result in significantly decreased costs related to treatment of associated complications……It is estimated that people with AKI stay in hospital an average of 4.7 days longer than the people of the same age in the same HRG without AKI.(4) The cost of stay depends on the speciality in which the person is treated, and the Payment by results tariff the spell is coded to. E.g each day’s stay in Intensive Care Unit costs an average of £1189.(5)

4: Kerr M, Insight Health Economics (2012) – Economics of AKI5: Hospital Episode statistics data (2012/13)

RenalGuard in Clinical Use

RenalGuard in Clinical Use

CTO: STATE OF THE ART Managing ComplicationsDr Colm Hanratty Belfast Health and Social Care Trust 76 year old graft failure, DM, Poor EF, CHF

Diagnostic angio 150 mls CTO PCI 360 mls50% increase Cr (no protection) with Renal Guard

7/11(pre) 13/11 (post)

Na 140 135

K 4.2 6.0

Ur 7.5 8.2

Cr 105 158

eGFR 60 37

18/01(pre) 21/01 (post)

Na 138 141

K 4.2 3.7

Ur 4.5 5.4

Cr 101 107

eGFR 62 58

How can RenalGuard help the Cardiologist?It can help in procedures where there large volumes of Contrast are used, and there is concern in damaging nephrons.

• Long Complex CTO’s• TAVI Diagnostic shots prior to main procedure –

remember most of these patients have poor renal function

• Looking for the Ostia in Graft procedures• Patients with low eGFR under 60 (as per BCIS

Guidelines )• Patients with high Serum Creatinine levels (300+) that

need PCI, but don’t want to put them into kidney dialysis - Hospital based haemodialysis costs £35,000 pa per patient.

CI-AKI and Long-Term Outcomes

1:QUA

LITY 2: PRICE

3: SAFETYAdditional training for Cath Lab Staff / Ward staff and physicians

Savings in overnight bed stay

Innovative new technology attracts CQUIN / CNST etc

Protocols for new procedure need to be created

IPROVEMENT IN PATIENT

OUTCOMES – POSITIVE

PUBLICITY !

Start: Aquilant make Case for a specific product with Acute Hospital

CCG approve ‘idea’ & Outline Business Plan – Clinical

Advocate then prepares FULL BUSINESS PLAN to represent to CCG for final sanction &

coding.

Hospital buy into ‘concept’, and wish to progress with ‘idea’

Is Hospital a Foundation Trust ? (FT)

YESNO

Hospital is FT, therefore as they

manage their own budgets, can buy without going to

the Clinical Commissioning Group (CCG)for

approval.

Clinical Advocate from Hospital, presents Outline Business Case to CCG to change current practise

o NB: Important to align any proposal with local or National Strategic Policies to add weight to argument.

• NB: Important to align any FULL BUSINESS PLAN with Hospital Quality & Safety Plans