a kidney*patient results monitoring service * a single centre pilot study

Geall, M, Stratton, J, Johnston, P, Dickinson, S, Parry, R
Department of Renal Medicine, Royal Cornwall Hospital Trust
INTRODUCTION: CKD presents an increasing health burden to society. There is a need to
continue to provide high quality care but at reduced cost. One mechanism for this would be to
reduce the number of patients seen in secondary care, but continue to provide supervision by
virtual or remote monitoring. A proposal for a pilot was agreed by the Medical Directorate and
was supported with funding from NHS Kidney Care, this was undertaken from June 2011 March 2012.
Patients with CKD 3 and 4 who had slowly progressive renal disease, or where stability
of their disease was unclear.
Patients on erythropoietin therapy who were otherwise suitable for discharge.
Patients with conditions which require no immediate treatment, but were future
treatment options may become available/necessary (for example patients with
polycystic kidney disease, or stable glomerulonephritis).
Patients were identified by database review and following outpatient clinic review. All patients
and GPs were sent letters and information sheets to explain how the service would function,
specifying when blood tests would be due. Test results were then reviewed by the specialist
nurse. If the results were stable letters were sent to the GP and the patient reassuring them that
there was no need to return to clinic at that time, and informing them of the date for future tests.
Patients whose blood results were not stable were brought to the attention of the consultant,
with regular review meetings. If during the monitoring service, a patient’s blood tests revealed
a significant deterioration, such that they required closer monitoring, they were referred back to
their original nephrologist
RESULTS: A total of 135 patients came under the care of the review service, 175 ‘tests’ were
reviewed, with 95 clinic visits saved. 11 were patients referred back to clinic, of those 8 had a
significant, progressive decline in eGFR, 1 had a high PTH and calcium level, and 2 had other
medical conditions requiring clinic review. An estimated 2,020 miles of patient travelling were
avoided, resulting in a saving of approximately 760 kgCO2e. Questionnaires showed both
patient and GP satisfaction. No safety concerns were raised during the pilot.
CONCLUSION: The kidney patient results monitoring service allows high quality care with
patient satisfaction, but at lower cost than traditional outpatient review. It was evident that
blood tests alone were not sufficient for monitoring CKD patients. Therefore, close
collaborative working with practice nurses and GPs is being developed, to ensure routine
urinalysis and blood pressure are carried out and that an awareness of patients’ medications is
maintained. Since the pilot finished, funding has been agreed for the service to continue.