4.5 Patient/Carer Experience

4.5.2 Convenience and Comfort of Dialysis Facilities

For the majority of ESRF patients, dialysis, once commenced, is for life. Despite the success of independent home treatment, now mainly by PD, the majority of patients require regular 'centre' HD. Ease of access to HD facilities is therefore of major importance. Thrice weekly treatment is the norm and the aim is to make the dialysis day as short as possible. Approximately half the patients on regular dialysis have their own transport, the other half being dependent on ambulance or hospital car services. A recent survey of UK HD units carried out for the Kidney Alliance showed that 4% of patients have a return journey of more than 4 hours for each dialysis session and 36% have a return journey of 2 to 4 hours (Keogh A - personal communication). Except in the most rural areas, a one way journey time of less than thirty minutes should be the aim for the majority. Even if that were achieved, transport dependent patients often have much longer journeys because of the need for a car to pick up several passengers. The placement of new HD facilities must reconcile travel times with the requirements of large towns where most patients live and economies of scale. Good road links and the availability of car parking are important considerations. Proximity to railway stations is also important. These issues are addressed in Section 5.8.

Comfortable waiting areas for patients are needed given that transport dependent patients may have long waits for their travel partners to finish dialysis. There has been a tendency in the past to design renal units along clinical lines. Since medical interventions are not common in routine maintenance dialysis, more emphasis could be given to the hotel ambience. The dialysis day can be made more bearable by comfortable chairs, relatively quiet surroundings, a degree of privacy, personalised TV/video and friendly administration so that patients can keep in touch with various activities and arrange appointments. It is desirable that consultant led clinics take place in the local facility. Travel to distant centres for routine review is second best. Although there is less need to decentralise PD close to patients' homes, it is generally appreciated if their follow up can also take place locally.