Remote monitoring for renal patients

Salford Royal Hospital, part of the Northern Care Alliance NHS Foundation Trust, provides renal services covering a population of 1.55 million people.

A pilot was designed to test and evaluate the impact of remote monitoring for renal patients in the Trust’s kidney clinic.

Situation

Patients in the kidney clinic are seen every 4 to 6 months for regular diagnostics.

Around 60% of these patients leave the clinic without any major changes to their treatment. Many of them could therefore be managed through a digital platform.

Key components of managing chronic kidney disease (CKD) include reviewing blood and urine tests, monitoring blood pressure and checking medications.

If the patient’s CKD is stable, managing their condition does not need face-to-face consultation.

Aspiration

The aim of the pilot is to:

• promote self-management of CKD
• modernise the delivery of outpatient services
• provide a surveillance safety net for patients with low risk of CKD progression, but not suitable for primary care follow-up
• reduce travel to the renal clinic
• reduce outpatient waiting lists for clinic appointments

Solution

DrDoctor Assessments streamlines information collection from patients before their appointment.

Patients are sent a blood form and instructions on how to get a blood test at a local healthcare provider before their appointment.

2 weeks before their virtual review, a text message is sent to the patient asking them to complete an online form.

The online form has 5 questions to assess if the patient’s outpatient follow-up appointment needs to be in person or remote. This provides vital information to clinicians before the appointment, helping them assess and make decisions on follow-up care.

Patients are asked:

• if they have had their blood tests (if the patient answers "no" they are reminded how important blood tests are and how to arrange them)
• for their blood pressure which is measured at home
• for their weight
• if they have been to hospital during the last 12 months
• if they have had any new health diagnoses in the past 12 months
• whether they have any new concerns about their kidney health

The questions were personalised to support the pilot. The questions helped clinicians decide if a patient needs a face-to-face, telephone or virtual appointment after submitting their diagnostics.

During a virtual kidney clinic, consultants review the patient’s responses, blood pressure, blood test results and medical history. They assess if the patient’s condition is stable and if they are on the most suitable treatment.

If new issues arise during the virtual review, the consultant arranges a follow-up.

The Patient Administration System (PAS) views the virtual clinic as a standard appointment.

Outcomes of the clinic are recorded on DrDoctor and PAS. Outcomes of the virtual clinic include:

• a follow-up appointment after 4 months
• a follow-up appointment after 6 months
• the patient did not engage so try again in 1 month
• a telephone appointment in the general nephrology clinic
• a telephone appointment in the specialist clinic
• a face-to-face appointment

No patient can be discharged from the virtual clinic.

Impact

Reducing travel to hospital helps to:

• save patients’ and clinicians’ time
• save patients’ money

A virtual appointment is also more convenient than a face-to-face appointment.

Services can reduce their telephone and face-to-face waiting lists by using remote monitoring.

Future improvements include making the virtual kidney clinic more efficient.

The team leading this pilot also believes that it saves time. They plan to compare the pilot against the time it takes to review a patient in a traditional clinic, which is approximately 15 minutes.

Functionality

• DrDoctor is cloud-based and accessible from any device connected to the internet.
• Patients are also given a telephone number to call if they need help.
• Patients receive a text message notification and reminders to let them know they need to fill in a form.

Capabilities

• Patients can fill out secure, personalised forms so clinicians are better informed before their appointment.
• The system helps clinicians decide if the patient needs a face-to-face, telephone or virtual appointment after they’ve submitted their diagnostics through the DrDoctor platform.

Scope

• Patients can fill out forms at home, saving them time in face-to-face appointments.
• Clinicians can configure and review forms in the same place.

Key learning points

• Get senior or, ideally, executive buy-in as early as possible to make it easier to get more clinicians on board. This gives the team more support with any barriers they encounter in set-up and sign-off.
• Involve administrative staff for help with coding and integration with PAS.
• Involve non-clinical project managers to speed up the set-up process and provide a link between digital and clinical teams.

Digital equalities

• There are safeguards in place to ensure that patients do not fall through any gaps.
• Only those who are fit to be managed virtually are included in the pilot.
• Patients need to have had 2 appointments with a consultant before being enrolled into the pilot virtual kidney clinic. This helps shared decision making and makes sure patients are receiving the best treatment.
• Patients can only have a virtual follow-up appointment where a relapse of their condition would be picked up by a change in urine or blood tests.
• The DrDoctor system will be developed further to include more languages to reduce health inequalities.

Key quotes

“The Salford virtual kidney clinic has allowed us to safely and effectively create capacity to begin to manage the elective care backlog, whilst also improving the experience for patients by avoiding unnecessary hospital visits.

Using digital tools to deliver new models of care whilst also enhancing patient safety gives us the opportunity to offer new models of service better aligned to patient needs without increasing work in other parts of the healthcare system.”

Dr Jim Ritchie, Program Director, Digital Control Centre, Chief Clinical Information Officer, Salford Royal NHS Foundation Trust

Key contact

Dr James Tollitt, Consultant Nephrologist, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust

james.tollitt@nca.nhs.uk

Shaun Cullen, Marketing Manager, DrDoctor

hello@drdoctor.co.uk