P21
SERVICE INNOVATION AND SAFETY OF NURSE- LED DAY CASE RENAL BIOPSYONE RENAL CENTER EXPERIENCE
Stott, A, Ullah, A, Raza, H, Anijeet, H, Ahmed, S
Renal Unit, Royal Liverpool University Hospital, Liverpool
INTRODUCTION: Day case renal biopsy represents a valuable, safe, and perhaps cost-effective
method of obtaining diagnostic renal tissue. There have been publications which have shown that in
a protocol driven day case biopsy setting, it is safe and reduces hospital admissions. However, there
is no approved national practice guideline on this issue to date. Day case biopsy protocol with
nurse- led pre assessment and discharge (as opposed to medic-led) can be viewed as a trend for
service innovation, workforce re-structuring, improving patient flow and patient experience.
Making such workforce changes generally requires developing effective protocols to ensure best
safe practice.
OBJECTIVES: The day case renal biopsy protocol is applied to patients who are clinically stable,
have no social issues and are able to be discharged on same day. This ensures that day case renal
biopsy is used on appropriate patients, who are fully informed of the risks and benefits. Patient
information leaflet are given to all patients prior to procedure. The policy applies to all patients
reviewed in renal clinics of a tertiary renal centre and covers a large geographical area (1.2million
population).
METHODS: Between May 2012 to November 2012, data was collected for all patients attending
for day case kidney biopsy. All patients were seen by Advanced Nurse Practitioner (ANP) one week
prior to biopsy, with the ultimate aim to ensure patient suitability for day case renal biopsy. All
blood tests, MRSA swabs taken and kidney ultrasound checked. The biopsy was performed by
trained renal registrars or renal consultants. All patient stayed at least 6 hours post biopsy as per
protocol. Information leaflet given and consent obtained. All of the patients are seen by ANP or
Renal Registrar prior to discharge.
RESULTS: Total of 67 patients’ results reviewed who met the criteria of day case biopsy as per
protocol. Among them, 63 (94%), patients discharged on same day. Only one patient stayed
overnight due post biopsy frank haematuria but settled without any intervention and was discharged
on following day (Table1). One patient stayed overnight for suboptimal BP control and other 2 for
logistical issues. Failure rate of obtaining kidney tissue on biopsy was 3% (n=2).
Table1: Results for day case renal biopsy
TOTAL
67
Same day
discharge
63 (94%)
Overnight
stay
4 ( 6%)
Complications from biopsy and
overnight stay
1
CONCLUSION: This audit data has demonstrated the feasibility, effectiveness and safety of a
protocol driven day case renal biopsy. Nurse led day case biopsy can help addressing the work force
development and re-structuring of services with improved patient outcome and experience.