Login to Access Video or Poster Abstract: MP95-17
Sources of Funding: None

Introduction

Applying guidelines to management of acute renal colic in the Emergency Department (ED) is challenging due to need to incorporate multi-specialty recommendations. A collaboration of urology and ED providers sought to better incorporate guidelines in the management of acute renal colic in the ED through resident education and initiation of algorithms. We hypothesized that these interventions would increase: use of ultrasound in appropriate patients, use of Tamsulosin for distal ureteral stones, and ambulatory referral to urology.

Methods

We conducted a study prior to and following introduction of the algorithm (Figure 1) and education session via retrospective chart review of patients diagnosed with nephrolithiasis in the ED at one academic institution.

Results

The pre-intervention and post-intervention cohorts included 469 and 80 patients respectively. Results summarized in Figure 2. Referrals to urology increased by 39% (p<0.05). Use of Tamsulosin for patients with distal ureteral stone and/or hydronephrosis had no significant change. Within the pre-intervention and post-intervention group there were 167 and 37 patients respectively, who met criteria to be evaluated by ultrasound. Use of bedside ultrasound in this group increased by 29% (p<0.05).

Conclusions

Collaborative resident education and joint development of management algorithms with urology and ED input, improve management of renal colic. We incorporated guidelines, including the American College of Emergency Physician’s “Choosing Wisely� campaign advocating ultrasound for evaluation of acute renal colic in patients < 50 years old with history of nephrolithiasis. The ED utilization of bedside ultrasound in this group rose significantly following the intervention. Additionally the intervention increased the ambulatory referral rate to urology. We did not impact the prescribing rate for Tamsulosin, however prescribing rates remained higher than published studies. Multidisciplinary collaboration can enhance utilization of guidelines and improve patient care.

Funding

None