Presentation Authors: Matt Archer, Amelia Pietropaolo, Davis Tanya, Sarah Prattley*, Bhaskar Somani, Southampton, United Kingdom
Introduction: Patients with kidney stones often need on-going follow-up and imaging surveillance adding to the clinical burden and cost of treatment. This is usually done in face-to-face clinical appointments. However, this can be avoided in suitably counselled patients who can have a telephone-based nurse led follow-up instead. We look at the outcomes of stone patients from our protocol-based virtual stone follow-up clinic.
Methods: Over a period of 5 years (2014-2018), all patients who were high risk of stone recurrence or with small asymptomatic stones were referred to our protocol-based nurse led virtual telephone stone clinic. The high-risk stone patient group included those with solitary kidneys, bilateral stones, those under 25 years of age, recurrent stone disease, uric acid and cystine stones. The follow-up duration and imaging were tailored and included a 6- or 12-months follow-up with either a plain KUB XR (radio-opaque stones) or USS (radio-lucent stone). The calculated followup cost was $23 for nurse led telephone clinics and $68 for face-to-face outpatient consultant reviews. The patients on the nurse-led pathway knew that a recurrence of symptoms or stone growth/recurrence or their personal preference would prompt a repeat clinic consultation.
Results: A total of 227 patients (39-49 annually) were referred to the virtual stone clinic for follow-up and surveillance of kidney stones with a mean age of 57 (range: 16-94) and a male:female ratio of 5:4. Of these 2(1%) declined a virtual follow-up and preferred a face-to-face consultation. Over a mean follow-up of 1.1 years (range 6 months - 2 years), 63(28%) have been discharged, 114 (50%) continue to be in the virtual clinic, 7 (4%) missed their follow-up and 41(18%) returned to face-to-face clinical consultation due to recurrence of symptoms or stone growth/recurrence. The imaging modality was with plain KUB XR in 79% and USS in 21% with 34 (15%) patients having more than one follow-up. Based on our model, the overall cost of follow-up reduced by a third from $17,750 to $5920 over the study period.
Conclusions: Majority of patients were happy for a virtual nurse led telephone clinic follow-up and half of them continue to be followed this way. Based on the clinical needs, this allowed some patients to be either discharged or returned for a face-to-face clinical consultation. This model not only provided a safe follow-up but also allowed to lower the cost by a third which helps to optimise healthcare resources and reduce the overall cost of treatment.