Ureteric Stone Referals: A review of compliance to National Guidelines at a Single Unit in London
BAUS ePoster online library. Sehgal R. Jun 25, 2019; 265254; CU-11
Radha Sehgal
Radha Sehgal
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Abstract
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Background:
Ureteric colic is a common presentation comprising a large proportion of urology admissions and outpatient clinic load. We aim to audit ureteric stone referrals against The British Association of Urological Surgeons (BAUS) standards for management of acute ureteric colic and develop recommendations ford service improvement.
Methods:
Retrospective analysis of patients attending stone clinic between 4th October and 15th November 2018 at a tertiary centre, with focus on investigation, management and follow-up.
Results:
55 patients were reviewed in stone clinic; referral sources were the Emergency Department (n=26), General Practitioners (n=12), hospital specialities (n=15) and other hospitals (n=2). Average time to follow-up was 90 days; on subgroup analysis, patients referred directly by urology were seen sooner (54 days) compared to other specialties (99 days). 58% of patients had evidence of urine dip and 27% urine culture. Blood tests arranged prior to referral were full blood count (80%), urea/creatinine (80%), C-reactive protein (72%), urate (31%) and calcium (45%). Computed tomography of kidneys/ureter/bladder (CTKUB) had been performed in most patients (71%); 11% had no imaging on referral. 4 patients underwent emergency intervention (stent insertion) and 10 patients a definitive intervention (ureteroscopy/lithotripsy).
Conclusions:
We have demonstrated substandard management and follow-up of patients with ureteric colic despite clear guidelines published by BAUS; in particular incomplete investigations and time to outpatient review exceeding four weeks. Recommendations to improve service include implementation of a 'hot' stone clinic, ureteric colic protocol, educational interventions and exploration of barriers to timely follow-up, following which we will re-audit the system.

INTRODUCTION
Urinary stone disease is a common surgical presentation with a lifetime risk of 6% in females and 12% in males1. It is associated w
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