NHS England - Transformation Directorate

Using a personal health record to improve patient engagement and deliver a digital dietetics service to kidney patients

The kidney dietetics service at Hull University Teaching Hospitals NHS Trust supports acute renal patients at Hull Royal Infirmary. It also manages an extensive cohort of outpatients through various satellite locations.

The specialist kidney dietetic team supports patients in:

  • general nephrology
  • pre-dialysis
  • haemodialysis
  • peritoneal dialysis
  • transplant

This clinic covers a wide geographical area. It includes Bridlington, Scunthorpe and Grimsby, with patients spread out as far as Doncaster, Lincoln, Scarborough and York.

Situation

During the second COVID-19 lockdown, the team could no longer access the satellite clinics and dialysis units. They also could not access high-risk patients who needed to self-isolate.

In order to stay in touch, the team needed a new way of working to maintain communication and support.

Aspiration

The department wanted to:

  • digitise the way they could support patients remotely
  • empower patients to manage their health and wellbeing
  • make better use of appointments by collecting data beforehand

Solution and impact

The service historically used Patient View (an online platform that gave renal patients a view of their clinical data). However, many features were missing which would offer renal patients a complete experience.

To ensure the service continued throughout the COVID-19 pandemic, the team introduced:

  • video and phone consultations
  • Patients Know Best (PKB)

This also supported the team’s broader ambitions to go digital.

The transition to PKB came at the right time. It instantly bridged the gap that the pandemic had created for professionals and patients.

The service considered how to make the best use of the extensive features in PKB. During the initial pilot phase the team focussed on PKB’s library, secure messaging, consultations and care plans.

The service identified a range of resources to support patients at all stages of their care.

These resources were added to the ‘Library’ feature so patients could access this information anytime. To begin with, the service added recipe books, YouTube tutorials, patient leaflets, links to charities and links to local health app libraries.

The service used two-way messaging to help patients and clinicians communicate remotely. Patients no longer had to leave answerphone messages and wait a couple of days for a response. The service was more responsive to a patients’ ‘real-time’ care needs.

The service chose to send patients questionnaires to complete online and return securely through PKB.

The first consultation created was for a ‘dietary recall’ which allows the kidney dietetics service to have a snapshot of a patient's nutritional intake.

By enabling an interactive two-way action plan of treatment, care plans were drawn up for bowel assessment, food diaries, nutritional screening and phosphate binder diaries.

Functionality

  • The cloud-based web app can be accessed by users on any device connected to the internet.
  • It integrates into the NHS app in many regions and can be requested by NHS customers for NHS Digital to enable.

The team is continuing to look at more ways they can benefit from the functionality available in PKB. They are now looking to collect questionnaire data from patients using a new fibre supplement for the Advisory Committee on Borderline Substances.

Capabilities

  • Since the implementation of PKB, the kidney dietetics service is better placed to support patients in the self-management of their renal condition.
  • Patients can add their own measurements and symptoms to keep an eye on and can contact the department for advice if they are concerned.
  • Allows for much better self-care and supports patient initiated follow-ups.
  • Patients are asked to update their care plans before their initial and follow-up appointments to enable more constructive dialogue with clear outcomes. These are recorded in the patient’s PKB health record. This allows patients, and anyone they choose to share their record with, to refer to this information to maintain integrated care and support at any time.

Scope

  • PKB is a portal between patients at home and clinical teams and is used in both settings.

Key learning points

  • It’s easy to sign patients up to the service.
  • Patients were registered with PKB during phone clinics and the process was complete before the call ended.
  • Patients were also signed up during video consultations which meant staff could share their screen to show the patient how to find information and use the various features.
  • Where possible, in face-to-face clinics the platform was demonstrated to patients and they were supported to register there and then.
  • Patients reported PKB was simple to navigate and use.

Digital equalities

  • Digital working is offered in addition to traditional services which now run in tandem. All patients continue to receive the same level of care but can choose which format is most suitable for them.
  • The platform has many features to support those less digitally-able, including carer functionality for proxy or supported access.
  • The platform is available in 22 different languages.

Key figures and quotes

  • In December 2021, 110 dialysis patients undertook nutritional self-screening via PKB to enable timely dietetic intervention for those with the highest clinical need.
  • The service has reduced its telephone messaging by 47% in a 12 month period reducing demand on healthcare staff.

“One great benefit we have found by using the messaging section is that we have been able to respond more quickly in requesting GP prescriptions, reducing the delay often seen when waiting for prescriptions to be generated and when treatment can commence. PKB enables me to promote patient-centred care by using it as an educational tool as well as a clinical tool.

The transformation for our service has been brilliant! We no longer have to rely on email to send patients their information and we can benefit from all the functions that PKB offers.”

Katherine Durrans, Clinical Lead Renal Dietitian

Find out more

Hull University Teaching Hospitals NHS Trust PKB case study

Video case study with Katherine Durrans

Video case study on the kidney dietetics service

Key contact

Sally Rennison, Vice President of Business Development, Patients Know Best

communications@patientsknowbest.com

Humber Coast and Vale PKB project team

humbercoastandvale@patientsknowbest.com

Jenifer Barker, Project Manager, Hull University Teaching Hospitals NHS

jenifer.barker@nhs.net

Katherine Durrans, Clinic Manager and Professional Lead Dietitian - Hull University Teaching Hospitals NHS

katherine.durrans@nhs.net