Full Report

The Context?
Chronic kidney disease (CKD) incurs substantial social and financial costs in NWT.
Between 2008 and 2011 alone, CKD accounted for more than 2,000 bed days each year
at an estimated cost of $5.2 million. 74 Yet NWT has no coordinated approach to renal
care, and the patient population is not clearly defined. In the absence of territorial
guidelines, individual health authorities have created and loosely followed their own
chronic disease management strategies. 75 The result is fragmented care practices and
an inability to properly identify the precise stage of renal disease in each patient. 76
Striving to improve coordination
The renal improvement team identified four issues
that contribute to the lack of coordination of renal
care services:
• Lack of renal disease data in NWT
• Informal disease definition
• Multiple uncoordinated entry points to
the current care system
• Poor communication between serviceand
system-level staff
Our goal: improve and integrate the provision
of renal care provided to NWT residents.
During CFHI’s training workshops, the team set its
goal to improve patient health outcomes by integrating
the provision, and increasing the consistency,
of renal care to NWT residents. The pilot project
engaged a team of nine frontline and department
staff in three key activities:
• Standardizing the definition and process
for primary care decision support of early stage
renal disease detection and management
• Creating a territorial renal database
• Establishing a single point of entry for renal
insufficiency clinics (RICs) and primary care
Pilot implementation took place between
September 2012 and March 2013. Yellowknife Health
and Social Services Authority (YHSSA) and Hay
River Health and Social Services Authority (HRHSSA)
supported the project by piloting a renal patient
database, while Stanton Territorial Health Authority
(STHA) made its central referral intake available
for use in the pilot.
Our approach
The improvement team began by developing
and disseminating evidence-based clinical
practice guidelines (CPGs; see sidebar) and a renal
patient referral process (see Appendix V). A range
of national and international sources informed
development of these tools, including the Northern
Alberta Renal Program (NARP), Canadian Diabetes
Association (CDA), the UK’s National Institute for
Health and Clinical Excellence (NICE), and Kidney
Health Australia.
As part of the validation process, the team circulated
the guidelines to the NWT Medical Director’s Forum
(MDF) and Nursing Leadership Forum (NLF) for
review. The MDF found the processes evidence-based,
clear, easy to follow and supported by best practice.
The MDF agreed that the processes would support
clinical decision-making and help improve the provision
of standardized renal care across the territory. 79
Making the Case for Change
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