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Establishing a tele-clinic service for kidney transplant recipients through a patient-codesigned quality improvement project
  1. Udaya Prabhakar Udayaraj1,2,
  2. Oliver Watson2,
  3. Yoav Ben-Shlomo3,
  4. Maria Langdon4,
  5. Karen Anderson4,
  6. Albert Power4,
  7. Christopher Dudley4,
  8. David Evans5,
  9. Anna Burhouse6
  1. 1Oxford Kidney Unit, Churchill Hospital, Oxford, UK
  2. 2Bristol Health Partners, Bristol, UK
  3. 3Population Health sciences, University of Bristol Medical School, Bristol, UK
  4. 4Richard Bright Renal Unit, North Bristol NHS Trust, Bristol, UK
  5. 5West of England Academic Health Science Network, Bristol, UK
  6. 6Rubis.Qi, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
  1. Correspondence to Dr Udaya Prabhakar Udayaraj; udaya.udayaraj{at}ouh.nhs.uk

Abstract

Kidney transplant patients in our regional centre travel long distances to attend routine hospital follow-up appointments. Patients incur travel costs and productivity losses as well as adverse environmental impacts. A significant proportion of these patients, who may not require physical examination, could potentially be managed through telephone consultations (tele-clinic). We adopted a Quality Improvement approach with iterative Plan–Do–Study–Act (PDSA) cycles to test the introduction of a tele-clinic service. We codesigned the service with patients and developed a prototype delivery model that we then tested over two PDSA improvement ramps containing multiple PDSA cycles to embed the model into routine service delivery. Nineteen tele-clinics were held involving 168 kidney transplant patients (202 tele-consultations). 2.9% of tele-clinic patients did not attend compared with 6.9% for face-to-face appointments. Improving both blood test quality and availability for the tele-clinic was a major focus of activity during the project. Blood test quality for tele-clinics improved from 25% to 90.9%. 97.9% of survey respondents were satisfied overall with their tele-clinic, and 96.9% of the patients would recommend this to other patients. The tele-clinic saved 3527 miles of motorised travel in total. This equates to a saving of 1035 kgCO2. There were no unplanned admissions within 30 days of the tele-clinic appointment. The service provided an immediate saving of £6060 for commissioners due to reduced tele-clinic tariff negotiated locally (£30 less than face-to-face tariff). The project has shown that tele-clinics for kidney transplant patients are deliverable and well received by patients with a positive environmental impact and modest financial savings. It has the potential to be rolled out to other renal centres if a national tele-clinic tariff can be negotiated, and an integrated, appropriately reimbursed community phlebotomy system can be developed to facilitate remote monitoring of patients.

  • chronic disease management
  • control charts/run charts
  • patient-centred care
  • Pdsa
  • quality improvement

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors UPU developed the idea of tele-clinic, led the project and wrote the manuscript. OW was the project manager collecting and analysing data. YB-S contributed to the project set up and commented on the manuscript. ML, KA, AP and CD conducted the tele-clinics and contributed to data collection. DE and AB provided expertise on quality improvement methodology and commented on the manuscript.

  • Funding We would like to thank the West of England Academic Health Sciences Network for their quality improvement expertise and for funding this project.

  • Competing interests AP reports personal fees from Vifor Fresenius Renal Pharma, personal fees from Bayer GmBH outside the submitted work.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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