Implementing the Sussex Renal Innovation Programme (SRIP

Anson R, Bravo F, Hudson C, Helliwell P, Darking M, Goldberg L
Sussex Kidney Unit
BACKGROUND: The Renal Innovation Programme (RIP) is a regional programme of patient
centred, information technology enabled service redesign that includes the implementation of an
upgraded electronic clinical information system (ECIS), regional laboratory results integration
and the use of video clinics.
PROBLEM: The Renal Services Information Strategy 2004 emphasises the importance of
ECISs in the development of renal care and management. However, understanding the precise
nature of these developments and their implications for improving patient safety, reducing costs
and improving the quality of care in renal services remain under-explored. We reviewed the
impact of RIP to date on the management of renal outpatients.
PROCESS: A multidisciplinary Action Learning Set was established in order to carry out the
implementation of RIP which includes representatives of the multidisciplinary team at our
Kidney Unit (KU), an expert patient representative, representatives from the ECIS technology
vendor and an academic socio-technical evaluator from the university. Clinical Vision 5 (CCL)
was the selected ECIS and an external project manager was contracted temporarily to oversee
procurement and implementation. A Superuser strategy and cascade model of training was used
to ensure that 100 current staff at the KU and satellite regional centres were given role-specific
training. Video-assisted remote clinics were piloted.
Each modality process-mapped their department’s work in advance of implementation.
Concurrent to these activities, video clinic trials were conducted and carried out from distant
outreach clinics.
RESULTS: Clinical Vision 5 was successfully implemented in December 2010. In the
outpatient (OP) department process mapping identified an excessive use of clerk and nurse time
in pulling nursing folders and handwriting clinical observations and laboratory results in flow
sheets before and after OP clinics. This has been replaced by the electronic recording of weight
and urinalysis which has led to easier identification and analysis of trends. Initially for CKD 5
pre-dialysis patients, then for stages 3 and 4 CKD patients, nursing folders became redundant
saving staff 15 hours per week in pulling and filing folders, and charting results. In June 2011
integration of CV5 with Renal PatientView was achieved resulting in fewer patient phone calls
to request results.
Two pilot video-assisted clinics for patients based to the east of our catchment area were
successfully conducted, saving 9 patients an extra 70 mile journey to the main KU clinic
(further development of this service is ongoing).
CONCLUSIONS: The ECIS was successfully implemented into the Sussex Kidney Unit as a
result of the collaborative, user-led project approach and has changed working practices in the
outpatient department to the benefit of staff and patients. Despite increasing patient numbers,
there has been a reduction in staff time required for running these clinics, allowing staff roles to
be changed to support the anaemia management and transplant clinic. Future developments will
include the application of this methodology to other clinics, the development of interfaces to
allow the automatic transfer of laboratory results from remote trusts in the network into Clinical
Vision 5, and the introduction of an analytics module.