{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T08:53:11Z","timestamp":1789548791468,"version":"build-2803163510"},"reference-count":8,"publisher":"BMJ","issue":"2","funder":[{"name":"WEST OF ENGLAND ACADEMIC HEALTH SCIENCES NETWROK"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open Qual"],"accepted":{"date-parts":[[2019,3,3]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:p>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\u2013Do\u2013Study\u2013Act (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 kgCO<jats:sub>2<\/jats:sub>. There were no unplanned admissions within 30 days of the tele-clinic appointment. The service provided an immediate saving of \u00a36060 for commissioners due to reduced tele-clinic tariff negotiated locally (\u00a330 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.<\/jats:p>","DOI":"10.1136\/bmjoq-2018-000427","type":"journal-article","created":{"date-parts":[[2019,4,9]],"date-time":"2019-04-09T08:05:16Z","timestamp":1554797116000},"page":"e000427","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Establishing a tele-clinic service for kidney transplant recipients through a patient-codesigned quality improvement project"],"prefix":"10.1136","volume":"8","author":[{"given":"Udaya Prabhakar","family":"Udayaraj","sequence":"first","affiliation":[{"name":"Oxford Kidney Unit, Churchill Hospital, Oxford, UK"},{"name":"Bristol Health Partners, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Watson","sequence":"additional","affiliation":[{"name":"Bristol Health Partners, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoav","family":"Ben-Shlomo","sequence":"additional","affiliation":[{"name":"Population Health sciences, University of Bristol Medical School, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Langdon","sequence":"additional","affiliation":[{"name":"Richard Bright Renal Unit, North Bristol NHS Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Anderson","sequence":"additional","affiliation":[{"name":"Richard Bright Renal Unit, North Bristol NHS Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Power","sequence":"additional","affiliation":[{"name":"Richard Bright Renal Unit, North Bristol NHS Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Dudley","sequence":"additional","affiliation":[{"name":"Richard Bright Renal Unit, North Bristol NHS Trust, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Evans","sequence":"additional","affiliation":[{"name":"West of England Academic Health Science Network, Bristol, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Burhouse","sequence":"additional","affiliation":[{"name":"Rubis.Qi, Northumbria Healthcare NHS Foundation Trust, North Shields, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,4,8]]},"reference":[{"key":"2025083111051217000_8.2.e000427.1","unstructured":"UK Renal Registry. Think Kidneys. 2016 https:\/\/www.thinkkidneys.nhs.uk\/ckd\/ (Accessed 03 May 2018)."},{"issue":"suppl1","key":"2025083111051217000_8.2.e000427.2","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1159\/000481364","article-title":"UK Renal Registry 19th Annual Report: Chapter 2 UK Renal Replacement Therapy Prevalence in 2015: National and Centre-specific Analyses","volume":"137","author":"MacNeill","year":"2017","journal-title":"Nephron"},{"key":"2025083111051217000_8.2.e000427.3","unstructured":"National Institute for Health and Care Excellence. NICE Guidelines [CG182] Chronic kidney disease in adults: assessment and management, 2014. https:\/\/www.nice.org.uk\/guidance\/cg182 (Accessed 03 May 2018)."},{"key":"2025083111051217000_8.2.e000427.4","unstructured":"NHS England. Next steps on the NHS Five Year Forward View. 2017 https:\/\/www.england.nhs.uk\/wp-content\/uploads\/2017\/03\/NEXT-STEPS-ON-THE-NHS-FIVE-YEAR-FORWARD-VIEW.pdf (Accessed 03 May 2018)."},{"key":"2025083111051217000_8.2.e000427.5","doi-asserted-by":"publisher","DOI":"10.7861\/clinmedicine.11-3-242"},{"key":"2025083111051217000_8.2.e000427.6","first-page":"132","article-title":"Telehealth in nephrology health care: a review","volume":"8","author":"Blinkhorn","year":"2012","journal-title":"Renal Society of Australasia Journal"},{"key":"2025083111051217000_8.2.e000427.7","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j3453"},{"key":"2025083111051217000_8.2.e000427.8","unstructured":"National Energy Federation www.carbon-calculator.org.uk (Accessed 01 Aug 2017)"}],"container-title":["BMJ Open Quality"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjoq-2018-000427","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T18:05:20Z","timestamp":1756663520000},"score":1,"resource":{"primary":{"URL":"https:\/\/qir.bmj.com\/lookup\/doi\/10.1136\/bmjoq-2018-000427"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4]]},"references-count":8,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2019,4,8]]},"published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1136\/bmjoq-2018-000427"],"URL":"https:\/\/doi.org\/10.1136\/bmjoq-2018-000427","relation":{},"ISSN":["2399-6641"],"issn-type":[{"value":"2399-6641","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4]]}}}