UK Service Keeps High-Risk Patients Out of Hospital

LONDON — February 2021 — A home specimen collection service launched in late 2020 by Guy's and St Thomas, an NHS Foundation Trust hospital in London, is designed to keep high-risk patients out of the hospital, reducing their exposure to COVID-19. This service was rolled out before the highly contagious variants of COVID-19 began spreading in the UK. The Guy's and St Thomas service is similar to a service started by Nottingham University Hospitals NHS Trust for children with kidney transplants, though it's the first of its kind in London. Both programs are examples of a trend toward remote monitoring services that protect high-risk patients by keeping them safe at home while enabling them to continue receiving virtual care and lab tests.

Organ transplant patients are considered a particularly high-risk group that is vulnerable to COVID-19. After transplant surgery, patients require follow-up care and regular blood testing to track their progress on therapeutic drugs aimed at maintaining organ function and preventing organ rejection. Such drugs must be monitored closely for dosage adjustments to prevent complications and ensure the therapy is effective. However, frequent visits to the hospital or lab for testing and monitoring is not ideal during a pandemic.

Guy’s Hospital, one of England's largest transplant centers, treats a signficant number of patients that are situated across southern England. Patients often travel long distances to visit the hospital for their follow-up tests and monitoring. To help reduce their travel and keep them safe, 23 adult patients recently received a home collection kit in the post from Guy’s and St Thomas’. They have been collecting and submitting their own blood samples remotely ever since, and using virtual consultations to follow up with the care team at the trust.

The home kits contain a Mitra^® device from Neoteryx, along with supplies and instructions on how to self-collect a sample. Patients use the finger-prick method and a Mitra^® device to collect a small sample of blood on the device’s absorptive tip. The sample is sent back to the Biochemical Sciences lab at St Thomas’ Hospital for analysis in a pre-paid envelope, included in the kit, which can be sent in the normal post. Once samples are received, test results are issued within 72 hours by the lab, which is run by Guy’s and St Thomas’ pathology provider Viapath.

Dr. Rachel Carling, consultant scientist at Viapath, said, “We wanted to help clinical teams find a good solution for adults and children who have had transplants to get the blood tests they need without coming into hospital."

Viapath worked hard to set up an effective method for use with the Mitra devices and to process the samples taken with them. Around 100 samples were analyzed and more than 50 adults and children were observed using the devices in clinic to ensure they were able to use them easily and effectively. The teams also worked with biochemists at Wythenshawe Hospital, part of Manchester University NHS Foundation Trust, who shared their methods of processing the tests in the labs.

"Through collaborative work with the renal teams at Guy’s and Evelina London Children’s Hospital, as well as with the teams in Nottingham and Manchester, we were able to get the service up and running for patients as soon as possible," said Dr. Carling. Test results are entered onto the Trust’s Electronic Health Record where they can be accessed by clinicians and patients. 

According to Dr. Dimitrios Moutzouris, a renal consultant at Guy's and St Thomas', the care teams had been seeking a way to monitor kidney function and anti-rejection medication levels at home without compromising the quality of the service. 

“Due to COVID-19 we are trying to reduce hospital visits, especially for those classed as extremely clinically vulnerable, which includes solid organ transplant recipients," said Dr. Moutzouris. "After an organ transplant, patients usually need blood tests twice a week for the first month, then the frequency gradually decreases over time. He added that finger-prick sample collection can be done at any time at home, and the Mitra device keeps a blood sample stable for up to 14 days. An additional advantage of finger-prick blood collection? Kidney patients often have difficult veins, and the finger-prick tests preserve veins more than standard blood tests do.

Dr. Moutzouris said that home testing creates more capacity in clinic for other patients who need to come in, while reducing overall numbers. Some health details still need to be checked in clinic, so the care teams are trying to alternate hospital visits with home specimen collection to reduce the number of overall visits for each patient. 

About Guy's and St Thomas'
As part of the NHS Foundation Trust and of King's Health Partners, an academic health sciences centre, we're pioneers in health research, and provide high-quality teaching and education. This partnership helps us provide the latest treatments alongside the best possible care. We are guided by our values: putting patients first, taking pride in what we do, respecting others, striving to be the best and acting with integrity. Our governors and members help to make us a successful NHS foundation trust by ensuring we meet the needs and expectations of our patients. For more information, visit www.guysandstthomas.nhs.uk