"Pretty good care for renal stones"

New Year’s Eve is not a great time to develop another bout of renal colic. Amazingly the practice had an online appointment which I booked in the New Year period to be seen around that time. The nice GP referred me to Urology at Ipswich using Choose and Book (after offering a choice of hospitals).

After hearing nothing I phoned the Urology Secretaries 5 days later and left a message. They phoned back that day with an appointment for a CT scan (14 days after start of colic) and I was subsequently seen in Urology Out Patient 21 days after the pain began.

Jack the Urology Registrar explained that I had an impacted 7mm stone that would need to be lasered via ureteroscopy leaving a ureteric stent in place afterwards. Mr Howizy the consultant confirmed this plan and I went to have bloods and pre-op assessment so as to be ready to be admitted as an urgent day case. All very good.

Phlebotomy clinic was chaotic both times I went – around 30-50 people waiting, some with appointments, others like me picking up a number and waiting to be called. I waited about 75 minutes with people additionally frustrated because the hospital car parks were full and people with appointments were arriving late and then having to be fitted in.

So 28 days after the colic began I had the operation. By this time blood tests showed that my renal function had begun to deteriorate somewhat due to back pressure from the impacted stone and I had begun to feel distinctly unwell. Happily once the stone was lasered away I immediately began to feel much better and 12 days later the stent was removed very efficiently by Mr Howizy via an Out Patient cystoscopy using local anaesthetic (which is much less painful than it sounds guys).

So what did I learn from all this?

• Firstly I was impressed by Ipswich Hospital Trust. Within the on-going winter pressures and A&E crisis they managed the sequence of scans, OP appointment and operation reasonably effectively. I was seen within 10 minutes of the appointment time on all three occasions and staff were full of information.

• Due to my work I have visited many trusts in England over the last 10 years and my own personal test of hospital culture is to stand at a busy intersection in the hospital and look lost. In some trusts lots of staff will walk straight by without asking if they can help. On every occasion that I did this in Ipswich the very first staff member who passed me always stopped to ask where I was wanting to go. Impressive.

• As always across the NHS there were many outstanding people – Janey Ruffles in Urology Admin, Nikki Slocum the nurse in the Radvargh Day Unit, Mr Howizy himself and Jack the registrar were all examples of thoughtful, courteous care.

• The phlebotomists were individually nice but working in a system that creates bottle necks and so inconveniences patients.

• The community ultrasound service, my general practice and the trust all said that the other organisations could access scans, discharge summaries etc. electronically. But none could actually call up the other organisation’s data when they needed it. IT integration that works for the clinician on the front line still has a long way to go.

• With all this help I avoided going to A&E (the pain wasn’t ever that bad) which, given the widely reported winter pressure going on at this time, presumably was important to the hospital and the system.

• But despite all this excellent care I waited 28 days for my impacted renal stone to be removed by the end of which my eGFR had begun to deteriorate. I am pretty sure that had I not been as knowledgeable about the system and how it should work I could have been waiting significantly longer than 28 days.

Perhaps I should have gone to A&E on News Year’s Day after all?