Acute Ureteric Stones - Using Quality Improvement Processes to Achieve the New BAUS and GIRFT Targets
BAUS ePoster online library. Balai E. Jun 25, 2019; 259471; P10-3
Edward Balai
Edward Balai
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Abstract
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Introduction:

Guidelines from the British Association of Urological Surgeons (BAUS) provide management standards for acute ureteric stones. These include a 4-week target for time from diagnosis-to-definitive management for those requiring intervention, and from diagnosis-to-clinic review in patients managed expectantly. The Urology GIRFT Report 2018 recommended that patients are offered specific stone clinics to offer conservative treatment; offered this follow-up in a timely manner; and provided timely readmission for definitive surgery where required.

We aimed to use quality improvement measures through plan-do-study-act (PDSA) cycles to try and improve our acute service and achieve these BAUS standards and GIRFT recommendations.

Materials and Methods:

First cycle changes aimed for a definitive procedure within 12 weeks, and introduced a stent theatre diary and stent education leaflet. The second cycle involved the introduction of a Consultant-led Acute Stone Clinic with a pathway for primary URS. The time to definitive procedure was re-examined after each cycle.

Results:

Percentage of patients receiving definitive procedure within 4 weeks improved from 3.2% to 98%. Over 50% of patients were seen in the clinic within 1 week of diagnosis; of those managed expectantly, 59% had a second clinic review within 4 weeks. Rate of re-presentation to A&E was reduced from 3.6 to 1.6 episodes/month.

Conclusions:

These processes have improved early definitive management rates as per BAUS and GIRFT guidelines. This has led to improved patient outcomes and experience, while helping to reduce the burden on our busy Emergency Department.
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