Emergency nephrostomy insertion out of hours: Transfer to a Tertiary Centre or wait for in-house interventional radiology services?
BAUS ePoster online library. Tien T. 11/11/20; 304227; P13-10 Disclosure(s): N/A
Mr. Tony Tien
Mr. Tony Tien
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Emergency nephrostomy insertion out of hours: Transfer to a Tertiary Centre or wait for in-house interventional radiology services?

Tien T1, Pieri M1, O'Connell N, Stephenson J1, Fang T1, Pal P1, Pathak S1, Graham S1
1Whipps Cross University Hospital, London, United Kingdom

Introduction:
The British Association of Urological Surgeons (BAUS) recommend urgent decompression of infected and obstructed urinary tracts within a maximum of 12 hours. District general hospitals in the United Kingdom tend to have interventional radiology (IR) on weekdays during normal working hours only (08:00-17:00). Patients requiring an emergency nephrostomy outside of normal working hours are often transferred to a tertiary centre where 24-hour IR is available. We aimed to assess the timings of decision, transfer and nephrostomy insertion from our unit.
Materials and Methods: All patients transferred from a single public funded hospital for an emergency nephrostomy insertion in 2016-2019 were included. Data on decision for transfer, arrival at tertiary centre and nephrostomy insertion were collated.

Results:
A total of 34 patients were transferred for emergency nephrostomy insertion in 2016-2019. However, 10 were excluded from analysis due to lack of documentation. On average, transfer to the tertiary centre took 5.3 hours (range 1-17 hours). Mean time from arrival at tertiary centre to nephrostomy insertion was 8.2 hours (range 0-33 hours). Mean time from decision to nephrostomy insertion was 13.9 hours (range 4-43 hours). Out of the 10 patients transferred on weekdays out of hours, 3 (30%) had a nephrostomy inserted overnight (17:00-08:00).

Conclusions:
Average time from decision to nephrostomy insertion out of hours from our unit was 14 hours. On weekdays, medical optimisation in the high dependency or intensive care unit until in-house IR is available during normal working hours can be considered, depending on patient condition and clinical urgency.
Emergency nephrostomy insertion out of hours: Transfer to a Tertiary Centre or wait for in-house interventional radiology services?

Tien T1, Pieri M1, O'Connell N, Stephenson J1, Fang T1, Pal P1, Pathak S1, Graham S1
1Whipps Cross University Hospital, London, United Kingdom

Introduction:
The British Association of Urological Surgeons (BAUS) recommend urgent decompression of infected and obstructed urinary tracts within a maximum of 12 hours. District general hospitals in the United Kingdom tend to have interventional radiology (IR) on weekdays during normal working hours only (08:00-17:00). Patients requiring an emergency nephrostomy outside of normal working hours are often transferred to a tertiary centre where 24-hour IR is available. We aimed to assess the timings of decision, transfer and nephrostomy insertion from our unit.
Materials and Methods: All patients transferred from a single public funded hospital for an emergency nephrostomy insertion in 2016-2019 were included. Data on decision for transfer, arrival at tertiary centre and nephrostomy insertion were collated.

Results:
A total of 34 patients were transferred for emergency nephrostomy insertion in 2016-2019. However, 10 were excluded from analysis due to lack of documentation. On average, transfer to the tertiary centre took 5.3 hours (range 1-17 hours). Mean time from arrival at tertiary centre to nephrostomy insertion was 8.2 hours (range 0-33 hours). Mean time from decision to nephrostomy insertion was 13.9 hours (range 4-43 hours). Out of the 10 patients transferred on weekdays out of hours, 3 (30%) had a nephrostomy inserted overnight (17:00-08:00).

Conclusions:
Average time from decision to nephrostomy insertion out of hours from our unit was 14 hours. On weekdays, medical optimisation in the high dependency or intensive care unit until in-house IR is available during normal working hours can be considered, depending on patient condition and clinical urgency.
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