Implementation of a clinical practice guideline for assessment and management of renal colic in the emergency department

Authors

  • Cecile T. Pham Department of Urology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia https://orcid.org/0000-0002-5954-565X
  • Nicholas Hui North Shore Urology Research Group, St Leonards, New South Wales, Australia
  • Regine Yan Department of Urology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia
  • Emma Richardson Faculty of Medicine, Western Sydney University, Campbelltown, New South Wales, Australia https://orcid.org/0000-0002-2198-7145
  • Salonee Phanse Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia
  • Jordan E. Cohen Faculty of Medicine and Health, University of New South Wales, Kensington, NSW, Australia https://orcid.org/0000-0001-9400-5707
  • George McClintock Department of Urology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia
  • Ahilan Parameswaran Department of Emergency Medicine, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia https://orcid.org/0000-0003-3670-255X
  • Matthew Smith Department of Emergency Medicine, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia
  • Andrew Mitterdorfer Department of Urology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia
  • John Boulas Department of Urology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia
  • Paul Gassner Department of Urology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia https://orcid.org/0000-0001-7196-5211
  • Dinesh Patel Department of Urology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia
  • Paul Sved Department of Urology, Bankstown-Lidcombe Hospital, Bankstown, New South Wales, Australia

DOI:

https://doi.org/10.5489/cuaj.8136

Keywords:

emergency department, practice guideline, renal colic, ureteral colic, urolithiasis

Abstract

INTRODUCTION: Renal colic is a common emergency department (ED) presentation. Variations in assessment and management of suspected renal colic may have significant implications on patient and hospital outcomes. We developed a clinical practice guideline to standardize the assessment and management of renal colic in the ED. We subsequently compared outcomes before and after guideline implementation.

METHODS: The guideline standardizes the analgesia regimen, urology consult criteria, imaging modality, patient education, and followup instructions. This is a single-center, observational cohort study of patients presenting to the ED with renal colic prospectively collected after guideline implementation (December 2018 to May 2019) compared to a control group retrospectively collected before guideline implementation (December 2017 to May 2018). A total of 528 patients (pre-guideline n=283, post-guideline n=245) were included. Statistical analysis was performed with SPSS using multivariate linear regression.

RESULTS: ED length of stay (LOS) was significantly shorter after guideline implementation (pre-guideline 295.82±178.8 minutes vs. post-guideline 253.2±118.2 minutes, p=0.017). The number of computed tomography (CT) scans patients received was significantly less after guideline implementation (pre guideline 1.35±1.34 vs. post-guideline 1.00±0.68, p=0.034). Patients discharged for conservative management had a lower re-presentation rate in the post-guideline group (12.6%) than the pre-guideline group (17.2%); however, this did not reach statistical significance (p=0.18).

CONCLUSIONS: Implementation of a clinical practice guideline for ureteric stones reduces the ED LOS and the total number of CT scan in patients who present with renal colic. Standardizing assessment and management of ureteric stones can potentially improve patient and hospital outcomes without compromising the quality of care.

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Published

2023-04-11

How to Cite

Pham, C. T., Hui, N., Yan, R., Richardson, E., Phanse, S., Cohen, J. E., McClintock, G., Parameswaran , A., Smith, M., Mitterdorfer, A., Boulas, J., Gassner, P., Patel, D., & Sved, P. (2023). Implementation of a clinical practice guideline for assessment and management of renal colic in the emergency department. Canadian Urological Association Journal, 17(7), E175–81. https://doi.org/10.5489/cuaj.8136

Issue

Vol. 17 No. 7 (2023): CUAJ July

Section

Original Research

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