The impact of a virtual nurse led x-ray review clinic in improving utilization of shockwave lithotripsy treatment slots

1. The impact of a virtual nurse led x-ray review clinic in improving utilization of shockwave lithotripsy treatment slots P 6-s Dickens N, Buchholz N.P, Masood J. Barts and The London NHS Trust, Department of Urology, London, United Kingdom. Objectives: As a result of expanding workload, we have introduced the role of an experienced clinical nurse specialist (CNS) to work within the stone team. Part of the remit includes a nurse led x-ray review clinic post extracorporeal shockwave lithotripsy (ESWL) in order to improve utilization of lithotripsy slots. Prior to implementation of this clinic, patients were given a further appointment for ESWL after the second treatment and, if found to be stone free at the third visit on x-ray, the slot was wasted. Now our patients are referred to the CNS led x-ray review clinic after second ESWL treatment to see if they are stone free or require further treatment. Patients attend for an x-ray two weeks post treatment and following this a decision is made to book further ESWL treatment, list for surgery or to review in the stone clinic. The patient is contacted by the CNS post x-ray and is informed of the treatment plan. We aim to ensure maximum utilization of ESWL treatment slots and present our results. Methods: Over the last one year our unit scheduled 498 repeat ESWL treatments. All patients were screened for suitability by the CNS. Out of these patients, 35 were removed from the ESWL waiting list after review of their post treatment x-ray by the CNS. Results: We found that 35 out of 498 patients (7%) did not actually require further treatment as scheduled. Of the 35 patients, 29 (83%) were referred back to stone clinic for routine follow-up as they were stone free, whilst 6 (17%) were listed for surgical removal of the stones. Conclusions: • By implementing a virtual nurse led, post ESWL x-ray follow-up clinic, there has been a reduction in patients attending for further treatment that is not required. This ensures ESWL slots are utilized more effectively and patients' treatment planned according to need. • As a result of the CNS reviewing patients’ x-rays after lithotripsy and hence ESWL slots being utilized more effectively, we have generated extra annual revenue for our trust of more than £17,500. • This data suggests that there is an important role for the CNS in ensuring an effective treatment plan is made for patients who have undergone ESWL. • Not only does it prevent the patient from attending for ESWL when it is not required, it also ensures we generate maximum income for our Trust by utilizing all slots effectively. • This practice also promotes further development and expansion of a nurse specialist’s role which is beneficial for patients’ care.