Enhancing the care of cancer patients with ureteral strictures managed with percutaneous nephrostomy tubes.

e264 Background: Ureteral strictures resulting from either active disease or the sequelae of cancer therapy are often managed with percutaneous nephrostomy (PCN) tubes. PCN tubes divert urine from the kidney into drainage bags, which are cumbersome to care for and potential sources of infection. In contrast, percutaneous nephroureteral (PCNU) tubes by allowing internal drainage can preclude the need for a urine drainage bag. Our goal was to implement a coordinated care program in interventional radiology (IR) designed to increase the number of patients whose PCN tubes were converted to PCNU tubes, thus preventing the long-term problems associated with urine drainage bags. Methods: An IRB approved retrospective review of all PCN tubes placed in IR from 2011-2013 was undertaken to get baseline statistics. After review of this data, a prospective care coordination program was implemented in which patients without contraindications for conversion to PCNU tubes had an attempt at conversion during their planned 3 month PCN tube exchange. The baseline and 1 year follow up data were collected. A Fisher’s exact test was used to calculate the significance of the intervention. Results: Our baseline data demonstrated on average 9% of PCN placements per year were being converted to PCNU tubes. After implementation of the prospective care coordination program from 7/2014 to 7/2015, 257 patients had PCN tubes placed. 217 patients had completed 3 month follow up at time of analysis. Of these, 30 (14%) patients had an attempt at PCNU placement because of the prospective program. Among these patients 19/30 (63%) had a successful PCNU placement. 20 (9%) patients had PCNU placement at the request of referring physicians. Overall, 39 (18%) patients had a PCNU tube placed after implementation of the program. 2/39 patients had difficulties with their PCNU tubes requiring return to PCN tubes. Conclusions: An active coordinated care program in IR aimed at preventing the long-term problems associated with PCN tubes and urinary drainage bags can increase the percentage of patients who receive PCNU tubes from 9% to 18% (p = 0.002).