Electronic Consultation (e-Consultation) Service for patients with Chronic Kidney Disease (CKD)

Key learning point 

Avoiding unnecessary secondary care referrals is an effective way of releasing resources in specialist units, saving on patient transport and other environmental costs.

Paper referral rates are likely to diminish when e-consultation is made available to all practices.

Setting/Patient Group: Renal department

Issue to be addressed:

A rising prevalence of recognised CKD requires strengthened communication between primary and secondary care.

Over 90% of the primary care practices in the local PCT use a centralised IT system (SystmOne®), allowing detailed electronic health records to be shared by groups of healthcare professionals in various care settings.

Intervention:

1. Development of CKD e-consultation service in SystmOne®
   1. Allowing GPs to send electronic referrals and obtain advice for specific queries
   2. Enabling renal specialists to access patient electronic records (with patient consent) such as co-morbidities details
2. System was piloted in a single practice with participating GPs attending education events and receiving paper and electronic guidance about the new service

Outcome:

Clinical

• Better coordination of patient management
• Avoidance of inappropriate clinic referrals
• Facilitated prompt and informative decision making by the nephrologist

Social

• Provision of timely, helpful advice and service
• Increased GP confidence in managing CKD in the community.

Environmental

• Avoidance of unnecessary hospital clinic visits saved on transport and other environmental costs
• Estimated carbon savings of approximately 40 kgCO2e per outpatient visit 

Economic

• 11 out of 68 (16%) e-consultations were finally referred to clinic, compared to 376 out of the 398 (94%) paper referrals between 2007 and 2008
• Saving transport and resource costs