Clinical safety and cost effectiveness of follow-up virtual clinic for bladder outflow obstruction surgery.

Sarmah, Piyush Bhargav; Broadley, Graham Alexander; Khwaja, Sikandar; Delves, George Henry

Introduction Bladder outflow obstruction (BOO) surgery is amongst the most commonly-performed urological procedures. Post-operative assessment consists of physical measurement of uroflowmetry and post void residual volume, but health systems worldwide have experienced pressures in demand, leading to exploration of greater efficiency in organising clinic protocols. International Prostate Symptom Score (IPSS) questionnaire measurement has been identified as a tool to predict change in post-operative management. Our institution established a nurse-led follow-up virtual clinic (VC) for patients undergoing BOO surgery based on IPSS measurement. We present the clinical and economic outcomes of this new service. Materials and Methods Patients with a successful post-operative trial without catheter (TWOC) were contacted by telephone via VC, and discharged by a Urology Clinical Nurse Specialist (UCNS) if IPSS was <8. Data was analysed for IPSS; arrangement of subsequent clinic visits; and numbers discharged. Primary outcome was the proportion of patients discharged after VC consultation. Secondary outcomes were overall discharge rate following subsequent face-to-face (FTF) appointment; and the proportion of patients re-referred from Primary Care within three months of discharge from VC. Cost savings were calculated based on tariffs of £135 for first attendance with UCNS; £199 for uroflowmetry; and £47.84 for VC appointment. Results The first 50 patients to be recipients of the new VC were included. Median IPSS and Quality of Life score were 13 (interquartile range 5) and 3 (interquartile range 1) respectively. 39 (78%) patients were discharged from VC; 36 (72%) had IPSS <8. Overall discharge rate following subsequent FTF appointment was 88%. Two patients discharged from VC (5.1%) were subsequently re-referred, neither of whom required additional treatment. Total cost savings with VC amounted to £10,634. Conclusion Telephone follow-up for BOO surgery based on IPSS is clinically safe and cost-effective, providing greater efficiency for clinic protocols.