MP95-18 VIRTUAL STONE CLINIC – FUTURE OF STONE MANAGEMENT?

Abstract

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II1 Apr 2017MP95-18 VIRTUAL STONE CLINIC – FUTURE OF STONE MANAGEMENT? Ola Blach, Thomas Smith, Stephania Baker, Leeanne Newman, and Andrew Symes Ola BlachOla Blach More articles by this author , Thomas SmithThomas Smith More articles by this author , Stephania BakerStephania Baker More articles by this author , Leeanne NewmanLeeanne Newman More articles by this author , and Andrew SymesAndrew Symes More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3020AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES NHS outpatient waiting lists are ever increasing. In January 2016, 976 patients were awaiting a Urology appointment in Brighton. Urgent referrals to a dedicated stone clinic were seen after 12-14 weeks, with routine referrals seen after 6 months. Patient experience was poor, with stone clinic DNA rates of 14%. Innovative changes were needed and a virtual stone clinic (VSC) was set up to improve the service. METHODS VSC set up was based on Brighton′s award-winning virtual fracture clinic. A consultant-led once-weekly VSC was supported by a MDT of the stone registrar, ESWL radiographer and stone nurse. Referrals were triaged direct from source (ED, GPs, in-patient teams, post-lithotripsy). A target of 20-30 patients per week was set and a tariff of £64 agreed. We aimed to assess the effectiveness following the first 2 months of running the service. RESULTS 212 patients were seen. 90 (42.5%) were discharged without any further investigations after the first VSC. Of the 122 (57.5%) who required follow up, 89 were brought back to the VSC, and only 33 patients (15%) were invited to attend face-to-face outpatient appointment, to either discuss more invasive treatment (PCNL) or for metabolic evaluation. 83% were discharged following a second virtual clinic review. Treatment was offered to 38 patients (18%); 23 had ESWL, 10 URS, 3 PCNL, and 2 stent/stent removal. Total income, over 2 months, from the 1h-long weekly VSC was £13 568, vs. £24 960 from 4h-long comparable outpatients clinics. The projected income, had the VSC run for 4h, would have however been £54 272. The 6 month waiting list was cleared in the 2 months period. All new referrals are now reviewed by a Consultant in less than 1 week. Feedback from patients was good with only 1 complaint (0.5%) and 8 DNAs (3.8%). We expect to see nearer a 1000 patients by May 2017, and will present updated results. CONCLUSIONS VSC is a viable and appropriate way for managing patients′ stones. It is cost effective and has a clear advantage with regards to reducing waiting lists. VSCs avoid the time consuming telephone follow-up clinic and free-up traditional outpatient appointments for other activity or complex metabolic stone patients. Early experience suggests patients enjoy the service. Virtual clinics have been gaining popularity across the world, improving the quality and access to care for patients. To the best of our knowledge, this is the first virtual clinic dedicated to patients with urolithiasis in the world. Given the encouraging preliminary results of our study, VSC has the scope to be introduced on a much wider scale. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1293 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Ola Blach More articles by this author Thomas Smith More articles by this author Stephania Baker More articles by this author Leeanne Newman More articles by this author Andrew Symes More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...