Ditch the Diaries: Peritoneal Dialysis Service Improvements

Abstract

Background: GIRFT recommends that at least 20% of dialysis patients start treatment on a home‑based pathway. At LTHT, the Peritoneal Dialysis (PD) service relied on informal processes, paper‑based systems, and a single Band 7 leader, creating variation and limited visibility of patient flow. Leadership changes and integration into the wider Home Therapies portfolio further exposed gaps in standardisation and proactive patient management. To deliver a safe and sustainable home‑based therapy model, the service required redesigned pathways, improved oversight, and more reliable, data‑driven processes. Aim: By September 2025, increase the capacity and capability of the PD service so it is prepared to support future growth in home‑based dialysis and work towards meeting the GIRFT expectation that 20% of dialysis patients are on home therapies. Methods: Five targeted Plan–Do–Study–Act (PDSA) cycles were undertaken in June 2025 to address key sources of variation. These focused on: implementing electronic scheduling; introducing electronic medication authorisation; establishing daily safety huddles; redesigning clinic templates increasing home‑based reviews; and standardising Peritonitis packs. Baseline, 30 and 60‑day measures assessed lead time, defects, sustainability, and staff morale. A multidisciplinary group (PD nurses, leadership, Renal Consultants, Administrative teams, Patient Partner, and the KPO) supported pathway mapping and testing. Results: All PDSA cycles delivered improvements. Electronic scheduling removed a daily 70‑minute delay and reduced defects from 60 to 22. Electronic signatures reduced processing time from 100 to 15 minutes. Staff‑reported morale increased from 2.7 to 4/5. Home‑based reviews increased from 18% to 34%. Standardised Peritonitis packs reduced set‑up time from 15 to 3 minutes. Despite a 9% rise in demand, home‑based treatment more than doubled, while hospital activity fell by 12%, avoiding 80 attendances. Conclusion: Targeted, co‑designed improvement interventions strengthened reliability, transparency, and resilience within the service, creating the operational capacity and cultural shift required to expand home‑based dialysis in line with GIRFT recommendations.