Page 11 - CUA2019 Abstracts - Miscellaneous/Other

2019 CUA Abstracts

formularies were trended over time and were also compared to the cost tant-led VSC between April 2018 and December 2018 and a pilot virtual
of a definitive surgical intervention. The costs of surgery represented a results clinic (VRC) between October 2018 and December 2018. VSC
maximum total cost associated with the procedure and were provided patients were referred following emergency presentation with a renal tract
by The Ottawa Hospital. stone. VRC reviewed scans of patients referred for hematuria but at the
Results: Substantial differences were found in cost between brand name time of a normal flexible cystoscopy were yet to have completed renal
and generic formulations for drugs commonly used to treat BPH (Fig. 1A). tract imaging (RTI). All patients subsequently received a letter with either
Substantial differences were also demonstrated in the cumulative cost of their VC outcome or further OPA.
androgen-deprivation therapy (ADT) treatments for metastatic prostate Results: In total 346 patients (male=163, female=183) were reviewed,
cancer (Fig. 1B). The costs of all ADT regimens studied surpassed the 287 and 59 patients within the VSC and VRC, respectively. All (100%)
cost of surgical castration by two years of treatment. had a VC appointment within two weeks of completed RTI or emergency
Conclusions: The formulation of medications prescribed by urologists stone referral. Eighty-nine (31%) VSC patients were discharged follow-
has a direct impact on the cost to payers. Surgical castration is far less ing one VSC review and 261 (91%) within two VSC. Four percent of
costly than medical castration. Where efficacy is equivalent, careful con- VSC patients required ureteroscopy and laser stone fragmentation. Forty-
sideration of treatment costs should be a further consideration when nine (83%) VRC patients were discharged following one VC; of these,
choosing therapy. three patients required referral to another specialty due to RTI findings.
This paper has a figure, which may be viewed online at: Nineteen of 346 patients (5%) required OPA for benign urological condi-
https://2019.cua.events/webapp/lecture/199 tions. The cost of 674 OPA avoided with VC was £40 440. There were
no patient complaints or reported adverse events.
Conclusions: With VC, we can more efficiently deliver results and dis-
MP-8.7 charge or refer patients on to other specialties, while reducing service costs
and overall OPA volume. Our patient satisfaction survey with the expansion
Risk factors for emergency visits following urological outpatient of our VC will determine the overall effect on patient experience.
surgery
Luke Witherspoon , Christopher Langley , Christopher Knee , Ranjeeta
2
1
1
Mallick , Rodney H. Breau , Ilias Cagiannos , Christopher Morash , MP-8.9
1
1,2
1
2
J. Stuart Oake , Luke T. Lavallee Does “MyChart” benefit “MY” surgery? – A look at the impact
1
1,2
1 Urology, The Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital of electronic patient portals on patient experience
2
Research Institute, The Ottawa Hospital, Ottawa, ON, Canada Naveen Kachroo , Sri Sivalingam 1
1
Introduction: Urological surgeries have been previously identified as 1 Department of Urology, Cleveland Clinic, Cleveland, OH, United States
having high rates of readmission compared to other surgeries. This study Introduction: Electronic patient portals can benefit both patient and pro-
aims to identify risk factors leading to presentation to the emergency vider, especially during the perioperative period, by providing timely
department (ED) following urological outpatient surgery. direct engagement and much-needed clarity to avoid unnecessary extra
Methods: We examined all outpatient surgeries performed by urology, provider encounters. Our study assessed patient portal usage among
general surgery, thoracic surgery, and gynecology occurring at three hos- endourology patients and whether this affected telephone call frequency,
pitals within The Ottawa Hospital system between April 1, 2008, and unscheduled provider visits, and emergency room (ER) presentations.
February 28, 2018. We captured all ED visits within 90 days of the out- Methods: We undertook a retrospective review of the electronic medical
patient procedure. Surgical characteristics included hospital campus, pro- records (EMR) of all patients undergoing elective endourology proce-
cedure end time, and day/month/year of procedure. Patient characteristics dures (shockwave lithotripsy [SWL], ureteroscopy [URS], and percutane-
assessed included age, sex, marital status, presence of primary care pro- ous nephrolithotomy [PCNL]) by a single surgeon at a tertiary urology
vider, socioeconomic status (SES), American Society of Anesthesiologists referral centre over a one-year period (July 2017 to July 2018). Patient
(ASA) score, and Elixhauser comorbidity index. demographics, operative details, patient portal (MyChart) registration,
Results: A total of 55 681 outpatient procedures were performed by the patient-initiated MyChart messages, telephone encounters, unscheduled
four services assessed over our time period; 7447 ED visits within 90 provider visits, and ER presentations during a one-month period before
days were identified (13.4% of total). Urological procedures accounted and after the procedure, were identified. Logistic regression analysis
for 59.5% (n=4427) of the patients returning to the ED. Univariable analy- assessed relationships between MyChart use and study outcomes.
ses of individual variables found that increased age, male sex, low SES, Results: We identified 313 patients (200 MyChart users, 113 non-users)
increased ASA score, unmarried status, increased Elixhauser comorbid- who underwent 374 procedures (SWL=3, URS=268, PCNL=103). MyChart
ity index, and hospital campus were all associated with higher rates of users were younger (mean age 56 vs. 61; p=0.0011) and more likely to be
ED visits (p<0.05). There did appear to be a significant difference in the married (69.5% vs. 48.7%; p=0.0004). MyChart users made less provider
rate of ED visits between year of procedure (p<0.0001) with a noted telephone calls, both prior to (mean calls 1.1 vs. 1.5; p=0.0037) and post-
decreasing trend. procedure (mean calls 0.9 vs. 1.3; p=0.021) and had less ER visits (8 vs.
Conclusions: ED visits following urological outpatient procedures are 19; p=0.0002). On multivariable analysis, non-users of MyChart were
common. This study identifies risk factors to identify patients that may 7.69 (95% confidence interval [CI] 2.44–25) times more likely to have
benefit from additional education or support after outpatient urological an unscheduled provider clinic visit (p=0.0004) and were 1.79 (95% CI
surgery to reduce ED care needs. 1.001–3.125) times more likely to have an ER visit.
Conclusions: Patients undergoing endourology procedures who use our
MP-8.8 patient portal make fewer telephone calls and are significantly less likely
to make an unscheduled clinic or ER visit, which will undoubtedly have
Virtual clinics: Our cost analysis and efficiency assessment a beneficial impact on their overall experience.
Elizabeth Osinibi , Helen A. Teixeira , Thomas Smith 1
1
1
1 Urology, Maidstone and Tunbridge Wells NHS Trust, Maidstone, United
Kingdom MP-8.10
Introduction: Virtual clinics (VC) can increase patient satisfaction and Gone girls: Where are all the women in urology?
service efficiency. Traditional face-to-face consultations can contribute Leandra Stringer , Heather Morris , Alp Sener , Ailsa May 2
1
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to costs incurred by patients, loss of earnings by attending outpatient 1 Urology, Western University, London, ON, Canada; Medicine, Schulich
2
appointments (OPA), and often anxiety while awaiting results. We School of Medicine and Dentistry, London, ON, Canada
sought to assess the efficiency and departmental cost savings of two Introduction: The number of female medical students and physicians
VC by creating a more streamlined, one-stop hematuria pathway and a entering the workforce is increasing. Despite this trend, some surgical
virtual stone clinic (VSC) assessing emergency stone referrals. specialties are still considered male-dominant. Urology has a significant
Methods: We conducted a prospective analysis of a once-weekly, consul- male predominance in both residency and independent practice. This
S138 CUAJ • June 2019 • Volume 13, Issue 6(Suppl5)