Intended for healthcare professionals


Self dialysis and video consultations feature in report on innovative care

BMJ 2015; 350 doi: (Published 18 February 2015) Cite this as: BMJ 2015;350:h837
  1. Zosia Kmietowicz
  1. 1The BMJ

When staff in the renal dialysis unit at Ryhov regional hospital in Jönköping, Sweden, were faced with increasing demand but no extra funding, Britt-Mari Banck, a nurse on the unit, said that staff “were not really excited.” But to see her now you would have to describe her as animated and proud.

The solution to the unit’s problem was to expand the number of dialysis stations from four to 12, but with an emphasis on self dialysis, where patients take full responsibility for setting up their machine, monitoring their treatment, and cleaning the equipment afterwards.

In a digital report by the healthcare think tank the King’s Fund,1 one patient, Patrik, described how he arrives at the unit at 7 am, lets himself in, sets up his station, and is well into his dialysis by the time staff members arrive at 8 am.

Banck describes how staff and patients on the unit have developed the service together, from learning how to use the new equipment to managing their care. It’s a flexible approach that puts patients at the centre and makes them experts in their condition. When a patient asks “What if I do this?” Banck treats it as a measure of the unit’s success.

The Jönköping hospital case study is just one example featured in the report that showcases innovative practice. It follows a programme set up by the King’s Fund in 2012 called “Time to think differently,” which sought to stimulate debate about the changes that the NHS and social care needed to make to meet the challenges of the future.2

The latest report also features the Bromley by Bow Centre in Tower Hamlets in east London, which offers housing, education, and employment support alongside healthcare, and the Interface Geriatric Service in Leeds, which provides various services for older people beyond hospital based care, blurring traditional boundaries between community and hospital services.

From the Netherlands the report highlights the work of Buurtzorg (“neighbourhood care),” the name given to specialist nurses who work in small teams to help meet the medical and social needs of patients but spend longer with each patient than traditional district nurses do. The model has been so successful it has been adopted in Norway, Japan, and the United States.

In West Yorkshire Airedale NHS Foundation Trust has a Telehealth Hub. Specialist nurse and consultant teams run a 24 hour video consultation service for patients and carers in more than 150 nursing and residential homes across the county, in prisons, and with some patients in their own homes. Through a secure, encrypted video link, staff can see the patient to diagnose, review, and assess their conditions, intervene to prevent deterioration, judge future care needs, and provide routine follow-up and outpatient services. Between April 2012 and March 2013 the scheme helped to reduce hospital admissions by 35% and visits to emergency departments by 53%, says the report.


Cite this as: BMJ 2015;350:h837