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E2397. Impact of Practicing Clinical Interventional Radiology: Nephrostomy Tube Care in Cancer Patients - A Quality Improvement Initiative
Authors
  1. Haoling Zhu; University of Texas Southwestern Medical Center
  2. Ayobami Odu; University of Texas Southwestern Medical Center
  3. Austin Franklin; University of Texas Southwestern Medical Center
  4. Daniel Lamus; University of Texas Southwestern Medical Center
  5. Yin Xi; University of Texas Southwestern Medical Center
  6. Anil Pillai; University of Texas Southwestern Medical Center
Objective:
To evaluate the impact of a defined quality improvement interventional radiology (IR) driven nephrostomy tube clinic on cancer patients in a high-volume tertiary care safety net hospital.

Materials and Methods:
A quality improvement (QI) process was established at our institution to increase compliance with percutaneous nephrostomy (PCN) tube follow-up care by starting an IR PCN care clinic in 2015. We conducted a retrospective review of 2 cohorts of cancer patients who underwent PCN placement either before or after implementation of the PCN clinic. The pre-implementation cohort (January 1, 2013 to December 31, 2013) was compared to the post-implementation cohort (January 1, 2018 to December 31, 2018) for compliance of follow-up tube exchange and complications of indwelling nephrostomy. Cost of emergency room (ER) and clinic visits (for the post-implementation cohort) as well as duration between exchanges were collected. Wilcoxon rank sum tests and Fisher’s exact test were used to test difference between pre- and post-implementation costs. Equality of variance in duration was tested using F test. P-value less than 0.05 was considered statistically significant.

Results:
For the 27 pre-implementation and 28 post-implementation patients, we included 38 and 31 exchanges, respectively. After the implementation of the IR PCN clinic, the 2018-2019 cohort had significantly lower standard deviation in the duration between exchanges than the 2013-2014 pre-implementation cohort (16 days vs. 48 days, p<0.0001), indicating better compliance of exchanges at 90 days. Additionally, the pre-implementation cohort had a longer duration between exchanges on average (95 days vs. 91 days, p=0.032). Of the 38 pre-implementation exchanges, 9 (24%) were preceded by at least 1 ER visit, while 4 (13%) out of 31 post-implementation exchanges were preceded by at least 1 ER visit (p=0.29).

Conclusion:
The implementation of an IR PCN clinic improves patient compliance of PCN exchanges every 3 months and may decrease ER visits prior to exchanges. The IR clinician plays a key role in management of these patients and improving their quality of life.