Virtual stone clinic – the future of stone management?

Abstract

Objectives: Increasing demands on the urology outpatient department at Brighton and Sussex University Hospitals (BSUH) have posed a significant challenge on the provision of a timely service for patients with stone disease. This study aimed to evaluate the patient outcomes and waiting times achieved with a newly implemented virtual stone clinic (VSC). Materials and methods: All new stone referrals received between August 2016 to January 2017 at BSUH were discussed in the VSC. Patients were reviewed within seven days of referral by a multidisciplinary team led by a consultant stone surgeon. A prospectively collected database was generated with primary outcomes including discharge to primary care, need for further diagnostics, re-review at VSC, direct booking for treatment and referral to a traditional outpatient stone clinic. Waiting times between the VSC and previously used outpatient stone clinic were also compared. Results: A total of 526 cases were reviewed in the VSC. One-quarter of patients were discharged following initial VSC review with a further two-thirds discharged after re-review. Treatment was offered to 101 patients, primarily in the form of lithotripsy (65%). Eighty-six patients required formal outpatient clinic appointments. Waiting lists for stone appointments were cleared within two months of implementation of the VSC. Outcomes were very favourable, with only three patients requiring emergency admission for management of their stone disease. Conclusion: The VSC model provides a clinically and cost-effective method of managing patients with urinary tract stones with significantly reduced waiting times and overall improved patient satisfaction. Level of evidence: Not applicable for this multicentre audit.