The Acute Stone Service Clinic: A New Pathway for the Management of Patients with Renal Colic
BAUS ePoster online library. Lee S. Jun 25, 2019; 259493; P12-9
Mr. Su-Min Lee
Mr. Su-Min Lee
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Abstract
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Introduction:
Renal colic patients presenting to the Emergency Department (ED) are typically managed symptomatically and discharged to a dedicated Stone Clinic. With increasing demands, time to follow-up has increased. To reduce this delay and associated patient morbidity, a new referral pathway is presented, the Acute Stone Service Clinic (ASSC).

Patients and Methods:

The ASSC involves Stone Multidisciplinary Team (SMDT) review of all ED referrals (<1 week), nurse telephone consult (NTC) within 12 days to evaluate symptom control and discuss management, and Combined radiographer/nurse Clinic (CC). Patients requiring emergency treatment were excluded.

Results:

Over five months, 365 patients were discussed in SMDT, with mean age 48 years (range 16-91) and 73% men. 103 (28%) patients had direct shockwave lithotripsy (SWL). NTC was required in 140 patients, and CC in 86 patients. Only 43% of patients required Consultant review, primarily for radiolucent, non-obstructing, or complex stones, or medical co-morbidities. After full evaluation, 7 patients were discharged, with 13 listed for surgery.

SMDT occurred within 1.9 days of referral (range 0-7) and NTC within 12 days. Over 90% of patients planned for CC were reviewed within six weeks (mean 32 days); eight further patients required immediate SWL. Overall, only 43% required a Consultant appointment.

Conclusion:
The ASSC has reduced treatment delays, evaluating 100% and treating 87% of patients within 2 and 6 weeks, respectively. With accelerated care in high-risk patients, all reported greater satisfaction from the early nurse-led telephone consultation. The ASSC has reduced the risk of patient morbidity and eased clinic pressures.
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