1. Renal Process Mapping from Renal Stakeholder Event Emergency Diagnostic tests ordered Secondary Referral General Practitioner General Practitioner Tertiary Referral RAC Inpatient Ward First contact with Nephrologist First contact with Nephrologist Blood Screen Urinalysis/24hr save Renal Biopsy 24hr blood pressure monitoring Ultrasound of kidneys Angiogram of renal vasculature Results Downloaded to MARS Database & PICS (electronic prescribing System) Results Downloaded to MARS Database & PICS (electronic prescribing System) Results to referring Clinician Results to referring Clinician Follow up Appt with Nephrologist & refer to Community Nursing Team Follow up Appt with Nephrologist & refer to Community Nursing Team No further action required. Discharge to referrer. No further action required. Discharge to referrer. CONSERVATIVE MANAGEMENT CONSERVATIVE MANAGEMENT Psychological support Physical support Prognosis and information Prognosis and information Modality Choice PERITONEAL DIALYSIS PERITONEAL DIALYSIS TRANSPLANTATION Not desired by patient Consultant/ Self referral Consultant/ Self referral Living Donor Desired by patient Cadaveric Transplant Transplant donor First stage Transplant donor First stage Transplant Assessment Recipient Transplant Assessment Recipient Bloods and TX Chat Bloods and TX Chat Suitable Not suitable Episode ends Second stage assessment Second stage assessment Psychological MRI ECG/CXR Echocardiogram/Angiogram Blood Tests Exercise tolerance test Results sent to Reviewed by Physician/ Surgeon Reviewed by Physician/ Surgeon Suitable Not suitable Episode ends Added to waiting list Pre-clerking Transplantation HAEMODIALYSIS Physical catheter placement Physical catheter placement Surgical catheter placement Surgical catheter placement Dialysis Access Formation Dialysis Access Formation Access Maturation 6-8 weeks Access Maturation 6-8 weeks CAPD training Failed CAPD access Dialysis via temporary Line Dialysis via temporary Line Failed/ Blocked fistula access Failed/ Blocked fistula access First and subsequent dialysis First and subsequent dialysis Dialysis work up Hepatitis vaccination Hepatitis vaccination Dietetic Advice Dietetic Advice Anaemia Management Anaemia Management Dialysis location Hospital Home Satellite Nephrologist refers to Vascular Access Co-ordinator appt booked at Vascular Access Co-ordinator appt booked at Radiological intervention PATIENT ENTRY POINTS INTO ACUTE CARE New Outpatient Appt Transplant Survival Transplant Failure Vascular Access Assessment Clinic Outpatient Appointment Ultrasound mapping of veins & surgical plan identified Ultrasound mapping of veins & surgical plan identified Patient Prioritised & listed for surgery (Pt must be fit and ready) Patient Prioritised & listed for surgery (Pt must be fit and ready) SURGERY For access formation (Day case/ Elective) Radiological intervention Venogram Venoplasty Venogram Venoplasty Transonic Monitoring (quarterly per protocol) Transonic Monitoring (quarterly per protocol) Pre-clerking Clinic Appt Refer back to Vascular Access Co-ordinator for review of access plan Refer back to Vascular Access Co-ordinator for review of access plan Community Nursing Team support/advise Community Nursing Team support/advise Modality Choice