Do you feel there are other benefits using single use device?
“As well as the benefits of moving stent removal out of the endoscopy suite and into the lithotripsy suite thus freeing up capacity in endoscopy, using the single-use device has also allowed us to remove stents in other places in the hospital such as: the accident emergency department, up on our urology ward or even on the oncology ward for patients who need to have their stents removed as soon as possible.
So I think this has brought significant benefits allowing us flexibility in stent removal in minimising waiting times for patients and therefore, hopefully improving their quality of life and in also keeping the patient journey closer to the stone team which has meant that we have managed to streamline our patients care.”
How long should a stent be left in a patient?
“A stent should be left in place for the minimum length of time and this is going to vary depending on the reason for placing the stent. If the stent has been placed because you were willing to come back and do a second look ureteroscopy or because access was not possible the first time, then obviously the stent will be left in place until you come back and have another look and undertake further surgery. If the stent has been left in place because there has been a ureteric injury for instance, then the length of time the stent is placed for will depend upon the severity of that injury.
Most commonly, a stent is left in place after surgery to allow the drainage of fragments and blood clots and to allow any oedema or swelling to settle down and in this case the stent is usually left between three days and two weeks but it should be left for the minimum length of time possible.”
How do you work with the procurement department in procuring Isiris α?
“In order to introduce Isiris α, we had to show our procurement department that the income gained by freeing up slots in endoscopy to allow our two-week wait haematuria patients to be seen was greater than the cost of purchasing the Isiris α device. As this was the case, we were allowed to introduce the Isiris α device and this was done over two years ago. And certainly procurement and ourselves have been very happy with the outcome of this.”
Did Isiris α improve quality of care for patients?
“I think Isiris α has made a significant improvement to quality of care for our patients. I think stent indwelling times postoperatively are minimised and I also think that the ability of having our specialist nurse who is part of the stone team remove the stent means that the patient’s pathway is streamlined. Having Isiris α generally in the hospital has also meant that we have been able to remove stents in some patients as an emergency, for instance, in the accident emergency department or up on the wards, giving us some flexibility in managing these patients.”
What difference Isiris α made in your day to day practice?
“Isiris α has made a considerable difference to my patients because now, when I place a stent after ureteroscopy, I will plan for it to come out at a particular time. Not only is the waiting list now under the control of Jane, our specialist nurse, but I also know that these patients are going to have their stents removed at the time that I requested it.
Prior to this, they would be removed in the endoscopy suite and due to pressures on waiting lists there, even though I might ask for a stent to be removed two weeks after placement, sometimes they would be removed a number of days or weeks after the required time. Obviously, we know that stents have a significant impact on patients quality of life, so removing them and leaving them in for the shortest time as possible is extremely important. Now the stents are placed and I know they will come out within the required time frame, which makes a big difference to me and to my patients.
Furthermore, because the stents are removed by Jane, who is a member of the stone team,
the patient’s future management is streamlined, meaning they have a reduced number of visits to see the stone service and to the hospital. So, I think this has also been a considerable benefit to my stone patients. Additionally, having Isiris α available in the hospital has meant that I have been able to remove stents as an emergency, either in the accident and emergency department when a patient has come in complaining of significant symptoms or for example on the ward, as I have had to do with some oncology patients who have become palliative. So I would say that having this portable device, which we can take and use not just in the lithotripsy suite but around the hospital, has really improved care for our urology patients.”
What is the current pathway for stent removal in your organisation?
“The pathway now for stent removal is that my patients will have a stent placed postoperatively
and I will then request Jane, my specialist nurse, to remove the stent in the required number of days. She will contact the patient and the patient will now come to the lithotripsy suite where Jane will remove the stent herself. Therefore, I know that the stent is removed and I know the stent is left in place for the minimum length of time.”
What is the main reason for moving to a nurse-led service?
“For us, moving to a nurse-led service meant that we could free up capacity in the endoscopy suite while our nurse removed stents in the lithotripsy suite. It also gave us the advantage of having the patient’s pathway under the care of the stone team at each step rather than being under the care of some other members of the urology team who do not necessarily specialised in stones. I think this has streamlined our patient’s pathway. I think it also means that a forgotten stent is less likely to occur as our specialist nurse, Jane, keeps a close tally on patients who have stents in and when they need to be removed.”
What was the impact of Isiris α in your organisation?
“The biggest driver for introducing Isiris α to our organisation was to free up capacity in our endoscopy suite. The issues with capacity and endoscopy really centre around the management of patients with suspected bladder cancer and our two-week wait haematuria patients.
We had considerable capacity constraints over managing those patients and making sure that they were seen in a timely fashion, which therefore led to delays in the management of our stented patients and removal of their stents. By removing the stent removals out of the endoscopy suite, we have therefore freed up capacity there and our two-week wait haematuria patients can be seen in these slots instead.”
What was the previous pathway for stent removal?
“Before the introduction of Isiris α, our stents were all taken out in the endoscopy suite. The endoscopy suite is where we undertake all our cystoscopies for the urology department and there were considerable pressures in the endoscopy suite, particularly for follow-up flexible cystoscopies for patients with bladder cancer and also for diagnostic pathways such as the two week wait haematuria pathway.
By removing the stent removals from the endoscopy suite and by the stent removals being undertaken in the lithotripsy suite by our specialist nurse, we freed up capacity allowing our hospital to meet the cancer targets for the two week wait haematuria patients.”
Why and when would you place a stent?
“I might place a stent in a urology patient either in an emergency setting (and this is usually when a patient presents a blocking ureteral stone either with or without infection) or I might place a stent after planned surgery such as a rigid or flexible ureteroscopy or percutaneous nephrolithotomy. In the latter example, stents are often placed to allow the drainage of fragments after what would usually be a complicated ureteroscopy or where there is a significant concern about infection after a procedure.”
