Login to Access Video or Poster Abstract: MP95-18
Sources of Funding: None

Introduction

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&[prime]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._x000D_ _x000D_ Treatment was offered to 38 patients (18%); 23 had ESWL, 10 URS, 3 PCNL, and 2 stent/stent removal. _x000D_ _x000D_ 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._x000D_ _x000D_ 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%)._x000D_ _x000D_ We expect to see nearer a 1000 patients by May 2017, and will present updated results. _x000D_

Conclusions

VSC is a viable and appropriate way for managing patients&[prime] 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._x000D_ _x000D_ 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._x000D_

Funding

None