ABSTRACT
Introduction: Patients presenting to the Emergency Department (ED) with renal colic are typically managed symptomatically and discharged to a dedicated Stone Clinic to ensure passage of stone. Due to COVID-19 and reduction in Consultant clinic capacity, it became apparent there was an increasing and significant delay in stone patients being reviewed, imaged and referred for intervention. To reduce this delay and associated patient morbidity, a new virtual acute stone clinic (VASC) was developed. Patients and Methods: The VASC involves a Nurse Specialist and Consultant. A new referral pathway from ED was created to ensure baseline imaging, metabolic screen and performance status completed. ED referrals are triaged within 1 week and follow up imaging arranged prior to virtual review (telephone or video consultation) at 4-6 weeks with the SNS. Results: Over three months, 105 patients were reviewed in the VASC, with mean age 52.2 years and 74% men. Time to review was reduced significantly with the mean time being 5.22 weeks. Only 31.4% of patients required Consultant review, primarily for radiolucent, complex stones or medical co-morbidities. After full evaluation, 12 patients were discharged, with 14 listed for stone intervention (ESWL or Ureteroscopy). Conclusion: The VASC has reduced treatment delays, time to be seen and associated morbidity from obstructing ureteric stones. Clinic pressures have been eased and consultant clinic capacity increased by the development of the VASC. The VASC has allowed training and development of the Nurse Specialist skill set with scope to evolve the clinic in the future.