Clinical, fiscal and environmental benefits of a specialist‐led virtual ureteric colic clinic: a prospective study

Abstract

ObjectivesTo evaluate the clinical, fiscal and environmental impact of a specialist-led acute ureteric colic virtual clinic (VC) pathway. Patients and MethodsAll patients with uncomplicated acute ureteric colic, referred to a single tertiary centre, were prospectively entered into the study over a 4-year period (January 2015-December 2018). Inclusion criteria were: low-dose non-contrast computed tomography of kidneys, ureters and bladder; white blood cell count <16 9 109/L; pain controlled; normal renal function; and no clinical concern. Primary outcomes were: time (days) from referral to VC outcome; VC outcome (discharge, further VC, face-to-face [FTF] clinic, extracorporeal shockwave lithotripsy [ESWL], ureterorenoscopy [URS], percutaneous nephrolithotomy [PCNL]); and adverse events (sepsis or obstruction). Secondary outcomes were patient and stone demographics, cost and environmental analysis. The minimum follow-up was 3 months. ResultsA total of 1008 patients entered the study, of whom 91.5% (n = 922) were of working age. The median (interquartile range) time from presentation to VC outcome was 2 (4) days. VC outcomes were as follows: 16.3% of patients (n = 164) were discharged; 18.2% (n = 183) were discharged after further VC; 17.2% (n = 173) underwent an intervention; and 48.4% (n = 488) were referred to an FTF clinic. Interventions comprised: PCNL 0.5% (n = 5); ESWL 7.7% (n = 78); and URS 8.9% (n = 90). Stone demographics were as follows: 570 patients (56.5%) had lower, 157 (15.6%) had upper, 96 (9.5%) had mid-ureteric and 163 (16.2%) had renal calculi, and in 22 patients (2.2%) the stones had recently passed. The mean (SD) stone size was 3.5 (2.3) mm. Two adverse events (0.2%) were reported. Introducing a VC saved £145,152 for Clinical Commissioning Groups, the equivalent NHS tariff payment of performing 106 URS procedures or 211 ureteric stent insertions. Overall, 15,085 patient journey kilometres were avoided, equal to 0.70-2.93 metric tonnes of carbon dioxide equivalent production and the need to plant 14.7 trees to achieve carbon balance. ConclusionA specialist-led acute ureteric colic VC reduced time to treatment decision to a median of 2 days. This creates additional clinic capacity and reduces the fiscal burden of traditional clinics and their associated carbon footprint.

Implementing Telemedicine for the Management of Benign Urologic Conditions: A Single Centre Experience in Italy

“…Our study reported the data of more than 600 phone counselling for urological benign pathology: notwithstanding the simple call may seem an obsolete approach for telemedicine and may even seem inadequate for clinical visits, it perfectly matches the recommendations of the European Association of Urology [8]. In fact, the phone call, performed by using hospital phones, can be considered the rst and easiest approach for telemedicine, as reported in previously published experiences, for the management of prostate cancer [11], hematuria [12], stones [13,14], urinary incontinence [15,16] and urinary tract infections [17].…”

COVID‐19 pandemic – is virtual urology clinic the answer to keeping the cancer pathway moving?

“…Virtual clinic is a form of telemedicine between healthcare professionals and patients that crucially occurs without the need for a traditional face‐to‐face consultation and thus avoids in‐person attendance at hospital [1]. Our group has previously published two large prospective studies confirming clinical equivalency, safety and acceptable patient satisfaction in both prostate cancer and the endourology setting [4,5].…”

“…Electronic health records have underpinned the ability to deliver virtual clinics within the NHS [4]. A number of commercial platforms now offer seamless video consultation within applications, such as EPIC ® (EPIC, Verona, WI, USA); however, we recognize that in times of emergency an absence of such ‘all‐inclusive, expensive, audio‐visual capable systems’ should not preclude emergency implementation within a trust (Step 3).…”

Understanding virtual urology clinics: a systematic review

“…Virtual clinics have been proposed as effective methods to accommodate increased urological service demands clinically and financially, whilst maintaining patient-centred care [6,7]. The primary aim of the present systematic review was to present current clinical, fiscal and environmental evidence on using urological telehealth and/or VCs.…”