Increasing demands on the urology outpatient department at Brighton and Sussex University Hospitals (BSUH) have posed a significant challenge on the provision of a timely service for patients with stone disease. This study aimed to evaluate the patient outcomes and waiting times achieved with a newly implemented virtual stone clinic (VSC). Materials and methods: All new stone referrals received between August 2016 to January 2017 at BSUH were discussed in the VSC. Patients were reviewed within seven days of referral by a multidisciplinary team led by a consultant stone surgeon. A prospectively collected database was generated with primary outcomes including discharge to primary care, need for further diagnostics, re-review at VSC, direct booking for treatment and referral to a traditional outpatient stone clinic. Waiting times between the VSC and previously used outpatient stone clinic were also compared. Results: A total of 526 cases were reviewed in the VSC. One-quarter of patients were discharged following initial VSC review with a further two-thirds discharged after re-review. Treatment was offered to 101 patients, primarily in the form of lithotripsy (65%). Eighty-six patients required formal outpatient clinic appointments. Waiting lists for stone appointments were cleared within two months of implementation of the VSC. Outcomes were very favourable, with only three patients requiring emergency admission for management of their stone disease. Conclusion: The VSC model provides a clinically and cost-effective method of managing patients with urinary tract stones with significantly reduced waiting times and overall improved patient satisfaction. Level of evidence: Not applicable for this multicentre audit.

PEG and 15% RIG. The mean insertion time from diagnosis was 11 months (+/-14 months), with 30 day mortality 1.9%. Overall mortality was 87% with mean survival from diagnosis 23 months (+/-16 months).The majority of PEG insertions were arranged on dedicated lists with anaesthetic cover (83% vs 17%) compared with only a minority of RIG insertions (18% vs 82%). There was no significant difference between time to insertion (P = 0.78) and survival from diagnosis (P = 0.61) between the 2 cohorts. Conclusions Gastrostomy use in the South West is safe, with mortality rates below quoted literature. Gastrostomy practice differs between the 2 hospitals in the approach used but time to insertion and mean survival was not different. The authors intend to pursue a joint referral pathway for gastrostomy assessment. This would improve data collection quality, allowing future analysis of standardised variables to ascertain the most effective use of gastrostomies in these patients.

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