Login to Access Video or Poster Abstract: MP95-19
Sources of Funding: none

Introduction

Pediatric nephrolithiasis is increasingly more common in the acute care setting. Variations in diagnostic evaluation and management may result in differing resource utilization and outcomes. Our institution developed a clinical pathway for the care of nephrolithiasis in the emergency department (ED) and inpatient settings. We describe the impact of the acute nephrolithiasis pathway on children who presented to our hospital with suspected or confirmed acute nephrolithiasis.

Methods

An evidence-based acute nephrolithiasis clinical pathway was developed by a multidisciplinary clinical working group, which guides decisions on usage of appropriate imaging, medical expulsive therapy, antibiotics, and urologic consultation. Electronic medical record (EMR) integration of the pathway allowed data on metrics of interest to be prospectively collected which could then be compared between pre-implementation and post-implementation periods.

Results

A total of 158 patients (114 pre-pathway & 44 post-pathway) were included, of which there were 124 (83 pre-pathway & 41 post-pathway) patients evaluated in the ED. There were no significant demographic differences in pre- and post-implementation groups in regards to age, race, medical complexity, or insurance status. Since October 2015, ED length of stay decreased from 359.3 minutes to 305.0 minutes (p-value 0.02), and admissions from the ED decreased from 41.0% to 24.4% (p-value 0.076). 30-day readmission rates following implementation of the pathway decreased from 14.3% to 9.7% (p-value 0.732). CT utilization in the ED decreased from 21.2% to 3.2 % (p-value 0.012). When inpatient CT utilization was added to analysis, the rate decreased from 23.7% to 9.1% (p-value 0.04), as shown in Table 1.

Conclusions

Implementation of a standardized, evidence-based pathway for pediatric nephrolithiasis management can improve quality without sacrificing patient safety. Our hospital saw significantly decreased CT scan utilization, and decreased ED length of stay and trends towards decreased admission rates with pathway implementation. 30-day readmission rates did not differ significantly, suggesting pathways can be implemented without negatively impacting short-term outcomes. There is additional room for optimization as process improvement continues.

Funding

none