Connor MJ. et al., 2019: Clinical, fiscal and environmental benefits of a specialist led virtual ureteric colic clinic: a report of a prospective study
Connor MJ, Miah S, Edison M, Brittain J, Kondjin Smith M, Hanna M, El-Husseiny T, Dasgupta R.
OBJECTIVES: To evaluate the clinical, fiscal and environmental impact of a specialist-led acute ureteric colic virtual clinic (VC) pathway. PATIENTS AND METHODS: All patients with uncomplicated acute ureteric colic referred to a single tertiary centre were prospectively entered into the study over a four year period (Jan 2015 - Dec 2018). INCLUSION CRITERIA: low-dose non-contrast CT KUB, WBC < 16 x 109 /L, pain controlled, normal renal function, no clinical concern. Primary outcomes: time (days) from referral to virtual clinic outcome, virtual clinic outcome (Discharge, Further VC, Face-to-face (FTF) clinic, ESWL, URS, PCNL), adverse event (sepsis or obstruction). SECONDARY OUTCOMES: patient and stone demographics, cost and environmental analysis. Minimum follow-up 3 months. RESULTS: 1,008 patients entered into the study, 91.5% (922) were of working age. Median time from presentation to virtual clinic outcome was 2 days (IQR 4). Virtual clinic outcomes were: 16.3% (164) discharged, 18.2% (183) discharged following further VC, 17.2% (173) intervention, 48.4% (488) FTF clinic. INTERVENTIONS: PCNL 0.5% (5), ESWL 7.7% (78), URS 8.9% (90). Stone demographics: 570 (56.5%) lower-, 157 (15.6%) upper-, 96 (9.5%) mid-ureteric, 163 (16.2%) renal calculi and 22 (2.2%) recently passed. Mean stone size of 3.5 mm (SD 2.3). Two (0.2%) adverse events reported. Introducing a VC saved £145,152 for clinical commissioning groups. The equivalent NHS tariff payment of performing 106 URS or 211 ureteric stent insertions. Overall, 9,374 patient journey miles were avoided, equal to 0.70 - 2.93 metric tonnes of CO2e production and the need to plant 14.7 trees to achieve carbon balance. CONCLUSION: Specialist-led virtual acute ureteric colic clinic reduces time to treatment decision to a median of 2 days. This creates additional clinic capacity, reduces the fiscal burden of traditional clinics and their associated carbon footprint.
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BJU Int. 2019 Jun 17. doi: 10.1111/bju.14847. Epub ahead of print
This article is an interesting report describing a new and fast organisation model, with the aim of deciding on the treatment or therapeutic needs of patients with acute stone colic. The organisation is termed “virtual stone clinic”. The decisions are made from examination of CT images and telephone communication with the patients. The authors concluded that the system resulted in a considerable time and cost saving. It is not quite clear from which level all patients came, because it seems reasonable that at many levels of the health care system these decisions also can be made directly where the patients primarily present with the symptoms. But inasmuch as this obviously is not possible everywhere the idea with a “control tower” seems interesting in order to maintain the quality and patient safety at a high and rational level.