BRIAR BENNETT1, Dr Adam Mullan1, Rian Gale1
1Health New Zealand, Whangarei, Aotearoa / New Zealand
Biography:
Briar Bennett is a Senior Renal Dietitian at Te Tai Tokerau/Northland Health NZ, and the lead renal dietitian for the Kidney Stone Prevention Clinic (KSPC). In 2023–2024, Briar led a promising quality improvement project that optimised the role of the renal dietitian within the KSPC service. With a background in public health and a strong interest in kidney stones, Briar is passionate about improving long-term kidney health through evidence-based dietary strategies, especially in rural and high-deprivation areas.
Aim:
To identify a sustainable model of care for kidney stone prevention to improve service safety, access, and equity in Te Tai Tokerau (Northland), Aotearoa.
Background:
Kidney stones can be acutely painful and may frequently reoccur, leading to diminished quality of life, increased emergency department visits, and a higher risk of kidney failure. The Kidney Stone Prevention Clinic (KSPC) at Health NZ – Te Tai Tokerau faced growing referrals, resulting in a waitlist of over 200 patients, with wait times reaching 1700 days. International best practice guidelines highlight the importance of dietary intervention for kidney stones.
Methods:
The quality improvement (QI) project required two phases. Phase 1 focused on information gathering, including clinical audit, patient and referrer feedback, and a national survey of current kidney stone prevention services. Phase 2 applied the Plan, Do, Study, Act methodology, utilising QI tools to guide possible solutions, including dietitian-led clinics, a referral streaming algorithm, a nurse-led engagement pilot, and reviewing communication pathways.
Results:
The KSPC waitlist reduced from over 200 to 89 patients in the first five months of phase two. “Long-waiters” (waiting over 365 days) decreased from 34 patients to one. Dietitian-led streaming utilised several significant clinical markers to identify cases suitable for dietitian-led clinics. A sample of 13 referrals showed nearly 40% could be streamed into dietitian-led clinics with virtual nephrologist review.
Conclusions:
Initial findings suggest a dietitian-led model for kidney stone prevention improves service provision, reduces waitlists, and releases nephrologist time for more complex cases. It aligns with best practice recommendations and offers a scalable, efficient, and sustainable template for similar services. Dedicated renal dietitian worktime is critical to ensure a sustainable service.