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Pilot Study of a Kidney Patient Results Monitoring Service
By: Royal Cornwall Hospitals NHS Trust
95% patients were happy with the way they received results. 86% patients felt that having blood tests taken at the surgery saved them time, money and the stress of travelling to hospital
£12,160 (Actual)
760kg CO2e (Estimated)
The renal department at the Royal Cornwall Hospitals NHS Trust conducted a ten month pilot study of a Kidney Patient Results Review Monitoring Service from June 2011 to March 2012. Patients with chronic kidney disease (CKD) III and IV were managed in primary care with secondary care supervision of blood results. Funding was offered via the Southwest Peninsula Network to set up a ‘virtual’ CKD clinic. Our team took up this opportunity, recognising the particular benefits in Cornwall, where rural patients currently travel long distances. The lead consultant was Dr. Rob Parry, supported by PRMS nurse, Mel Geall.The model successfully reduced the number of patient visits to renal outpatients, saving on patient time and travel, without compromising care.
Benefits to environmental sustainability
During the pilot, a total of 135 patients came under the review service, 119 of them were reviewed, with 95 clinic visits being saved. Mileage between the patients’ homes and the hospital where they attended their renal outpatient clinic were calculated using the ‘RAC Routeplanner’ website. A total of 2,020 miles were ‘saved’ resulting in a saving of 2020 miles x 0.37604 kgCO2e per mile* = 760 kgCO2e
It is also worth noting that some patients would be travelling to their appointments by ambulance or hospital funded transport.Two patients, who live on the Isles of Scilly, used to be flown by helicopter for each visit.
* total GHG conversion factor for medium cars using unknown fuel, taken from Annex 6 (Passenger Transport) of Defra 2012 greenhouse gas conversion factors for company reporting, available from: http://www.defra.gov.uk/publications/2012/05/30/pb13773-2012-ghg-conversion/)
Cost benefit
Costs: The pilot had funding for 1 day/week Band 6 specialist nurse and 2 hours/week consultant time (approx. £10,000 in total).
Savings: 175 tests were reviewed remotely, saving 95 clinic visits at a tariff of £128* = £12,160.
* 2011-12 PbR tariff for follow up attendance in nephrology, single professional
To see if carbon and patient time and money could be saved without compromising care
Negotiation is currently under way to agree a tariff to non face-to-face review, which will allow the service to continue long term.
Logistically, looking at all patients blood resultsis relatively straight forward, but monitoring patients bloods alone does not fulfil the requirements of the Renal National Service Framework. GPs are now being asked to ensure PRMS patients have blood pressure checked and urinalysis carried out.
01/06/2011
completed
£10,000
Patient numbers in the survey have been limited due to the limited time frame of study.
Mel Geall, PRMS Nurse, Mel.Geall@rcht.cornwall.nhs.uk