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INTRODUCTION We introduced a nurse-led virtual telephone-based stone follow-up clinic (VSC) for the surveillance of patients with asymptomatic renal calculi or those at a high risk of recurrent kidney stone disease (KSD). The aim of this study was to look at the outcomes of VSC and its role in the post COVID era. METHODS Prospective outcomes were collected for all patients referred to the VSC over a 6-year period (March 2014-April 2020). VSC is led by specialist stone nurses for on-going surveillance of KSD patients. RESULTS A total of 290 patients were seen (468 individual appointments; 1.6±1.0 per patient), with a mean age of 57.0±15.8 years (range:17-92) and a male:female ratio of 3:2. The referral was for surveillance of asymptomatic small renal stones (230,79.3%); history of recurrent stone disease (45,15.5%); solitary kidneys (5,1.7%); cystine stones, young age and other conditions (10,3.4%). The mean stone size was 5.0±2.7 mm, followed-up with XR KUB (225,77.6%) and USS (65,22.4%), for median duration of 12 months (range: 3-24 months). At the end, 132(45.6%) remained in VSC, 106(36.6%) were discharged, 47(16.2%) returned to face-to-face clinic or treatment, and 5(1.7%) had emergency admissions. Of 47 patients that returned, 23(48.9%) developed new symptoms, 21(44.6%) had stone growth, and 3 defaulted to face-to-face appointment. Thirty-five patients needed surgical intervention (URS-21, SWL-12 and PCNL-1) and 10 were managed conservatively. VSC reduced the cost per clinic appointment from £27.9 to £2/patient (93% reduction), equating to a total saving of £12,006 over the study period. CONCLUSION Nurse led VSC not only provided a safe follow-up, but also allowed to substantially reduce the cost of treatment by allowing patients to be either discharged or return to a face-to-face clinic or surgical intervention if needed. Post COVID, this model using telemedicine will have a much wider uptake and further help optimise healthcare resources.
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