MP95-17 MANAGEMENT OF ACUTE RENAL COLIC IN THE EMERGENCY DEPARTMENT: APPLYING GUIDELINES

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation II1 Apr 2017MP95-17 MANAGEMENT OF ACUTE RENAL COLIC IN THE EMERGENCY DEPARTMENT: APPLYING GUIDELINES Jessica Jackson, Jacques Farhi, and Noah Schenkman Jessica JacksonJessica Jackson , Jacques FarhiJacques Farhi , and Noah SchenkmanNoah Schenkman View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES 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. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1292 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jessica Jackson More articles by this author Jacques Farhi More articles by this author Noah Schenkman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...