Enhanced Acute Stone Service pathway for patients with renal colic: A 2 year review
BAUS ePoster online library. OCallaghan H. 06/21/21; 319118; p8-1
Disclosure(s): Recipient of the Endourology Society 2020 Summer Student Scholarship
Hyatt OCallaghan
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Abstract
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Introduction
Patients with stone-induced renal colic are at a higher risk of obstruction, acute kidney injury and sepsis. Early intervention avoids re-admissions, ancillary procedures and quality of life issues. For Emergency Department (ED) discharged patients (stable kidney function, no sepsis and controlled pain), referral to a stone clinic can be delayed. A unique 'hub and spoke' acute stone service (ASSc) pathway enabling accelerated care is reviewed.
Patients
Patients with CT-diagnosed stone from two hospital EDs were referred to the Stone multi-disciplinary team meeting (sMDT). Data included demographic characteristics, laboratory tests, imaging, patient contact dates and treatment plans. A 3-point ASSc pathway includes: (a) sMDT, (b) Nurse telephone clinic (NTC; <1 week) to evaluate symptoms, adequacy of pain relief and explain treatment plan, (c) and Combined Nurse & Radiographer clinic (CNRc) at 6 weeks with ultrasound & X-rays [Figure]. Patients were evaluated for symptom improvement, stone passage and renal function. Patient care could be enhanced at each patient contact.
Results:
Over 2 years 1363 patients were reviewed. Average time to NTC was 5.2 days. Target follow-up was less than 6 weeks; the mean was 5.6 weeks. 52% patients were managed conservatively; 20% were discharged; 35% had shock wave lithotripsy; and 9% ureteroscopy. Only 31% required a Consultant review for complex renal stones.
Conclusion:
ASSc provides enhanced care for acute stone patients, evaluating 93% of patients within 2 weeks, treating 85% of patients in less than 6 weeks. 69% of patients completed their care pathway without requiring direct Urologist consultation.
Patients with stone-induced renal colic are at a higher risk of obstruction, acute kidney injury and sepsis. Early intervention avoids re-admissions, ancillary procedures and quality of life issues. For Emergency Department (ED) discharged patients (stable kidney function, no sepsis and controlled pain), referral to a stone clinic can be delayed. A unique 'hub and spoke' acute stone service (ASSc) pathway enabling accelerated care is reviewed.
Patients
Patients with CT-diagnosed stone from two hospital EDs were referred to the Stone multi-disciplinary team meeting (sMDT). Data included demographic characteristics, laboratory tests, imaging, patient contact dates and treatment plans. A 3-point ASSc pathway includes: (a) sMDT, (b) Nurse telephone clinic (NTC; <1 week) to evaluate symptoms, adequacy of pain relief and explain treatment plan, (c) and Combined Nurse & Radiographer clinic (CNRc) at 6 weeks with ultrasound & X-rays [Figure]. Patients were evaluated for symptom improvement, stone passage and renal function. Patient care could be enhanced at each patient contact.
Results:
Over 2 years 1363 patients were reviewed. Average time to NTC was 5.2 days. Target follow-up was less than 6 weeks; the mean was 5.6 weeks. 52% patients were managed conservatively; 20% were discharged; 35% had shock wave lithotripsy; and 9% ureteroscopy. Only 31% required a Consultant review for complex renal stones.
Conclusion:
ASSc provides enhanced care for acute stone patients, evaluating 93% of patients within 2 weeks, treating 85% of patients in less than 6 weeks. 69% of patients completed their care pathway without requiring direct Urologist consultation.
Introduction
Patients with stone-induced renal colic are at a higher risk of obstruction, acute kidney injury and sepsis. Early intervention avoids re-admissions, ancillary procedures and quality of life issues. For Emergency Department (ED) discharged patients (stable kidney function, no sepsis and controlled pain), referral to a stone clinic can be delayed. A unique 'hub and spoke' acute stone service (ASSc) pathway enabling accelerated care is reviewed.
Patients
Patients with CT-diagnosed stone from two hospital EDs were referred to the Stone multi-disciplinary team meeting (sMDT). Data included demographic characteristics, laboratory tests, imaging, patient contact dates and treatment plans. A 3-point ASSc pathway includes: (a) sMDT, (b) Nurse telephone clinic (NTC; <1 week) to evaluate symptoms, adequacy of pain relief and explain treatment plan, (c) and Combined Nurse & Radiographer clinic (CNRc) at 6 weeks with ultrasound & X-rays [Figure]. Patients were evaluated for symptom improvement, stone passage and renal function. Patient care could be enhanced at each patient contact.
Results:
Over 2 years 1363 patients were reviewed. Average time to NTC was 5.2 days. Target follow-up was less than 6 weeks; the mean was 5.6 weeks. 52% patients were managed conservatively; 20% were discharged; 35% had shock wave lithotripsy; and 9% ureteroscopy. Only 31% required a Consultant review for complex renal stones.
Conclusion:
ASSc provides enhanced care for acute stone patients, evaluating 93% of patients within 2 weeks, treating 85% of patients in less than 6 weeks. 69% of patients completed their care pathway without requiring direct Urologist consultation.
Patients with stone-induced renal colic are at a higher risk of obstruction, acute kidney injury and sepsis. Early intervention avoids re-admissions, ancillary procedures and quality of life issues. For Emergency Department (ED) discharged patients (stable kidney function, no sepsis and controlled pain), referral to a stone clinic can be delayed. A unique 'hub and spoke' acute stone service (ASSc) pathway enabling accelerated care is reviewed.
Patients
Patients with CT-diagnosed stone from two hospital EDs were referred to the Stone multi-disciplinary team meeting (sMDT). Data included demographic characteristics, laboratory tests, imaging, patient contact dates and treatment plans. A 3-point ASSc pathway includes: (a) sMDT, (b) Nurse telephone clinic (NTC; <1 week) to evaluate symptoms, adequacy of pain relief and explain treatment plan, (c) and Combined Nurse & Radiographer clinic (CNRc) at 6 weeks with ultrasound & X-rays [Figure]. Patients were evaluated for symptom improvement, stone passage and renal function. Patient care could be enhanced at each patient contact.
Results:
Over 2 years 1363 patients were reviewed. Average time to NTC was 5.2 days. Target follow-up was less than 6 weeks; the mean was 5.6 weeks. 52% patients were managed conservatively; 20% were discharged; 35% had shock wave lithotripsy; and 9% ureteroscopy. Only 31% required a Consultant review for complex renal stones.
Conclusion:
ASSc provides enhanced care for acute stone patients, evaluating 93% of patients within 2 weeks, treating 85% of patients in less than 6 weeks. 69% of patients completed their care pathway without requiring direct Urologist consultation.
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