Abstract No. 511 Impact of practicing clinical interventional radiology: nephrostomy tube care in cancer patients, a quality improvement initiative

Abstract

To evaluate the impact of a defined quality improvement interventional radiology (IR) driven nephrostomy tube clinic on cancer patients in a high-volume tertiary care safety net hospital. A quality improvement (QI) process was established at our institution to increase compliance with percutaneous nephrostomy (PCN) tube follow-up care by starting an IR PCN care clinic in 2015. We conducted a retrospective review of 2 cohorts of cancer patients who underwent PCN placement either before or after implementation of the PCN clinic. The pre-implementation cohort (January 1, 2013 to December 31, 2013) was compared to the post-implementation cohort (January 1, 2018 to December 31, 2018) for compliance of follow-up tube exchange and complications of indwelling nephrostomy. Cost of emergency room (ER) and clinic visits (for the post-implementation cohort) as well as duration between exchanges were collected. Wilcoxon rank sum tests and Fisher’s exact test were used to test difference between pre- and post-implementation costs. Equality of variance in duration was tested using F test. P < 0.05 was considered statistically significant. For the 27 pre-implementation and 28 post-implementation patients, we included 38 and 31 exchanges, respectively. After the implementation of the IR PCN clinic, the 2018 to 2019 cohort had significantly lower standard deviation in the duration between exchanges than the 2013 to 2014 pre-implementation cohort (16 days vs. 48 days, P < 0.0001), indicating better compliance of exchanges at 90 days. Additionally, the pre-implementation cohort had a longer duration between exchanges on average (95 days vs. 91 days, P = 0.032). Of the 38 pre-implementation exchanges, 9 (24%) were preceded by at least 1 ER visit, while 4 (13%) of 31 post-implementation exchanges were preceded by at least 1 ER visit (P = 0.29). The implementation of an IR PCN clinic improves patient compliance of PCN exchanges every 3 months and may decrease ER visits prior to exchanges. The IR clinician plays a key role in management of these patients and improving their quality of life.