EAU 2019: Reducing Delay in Care for Patients with Obstructing Stones: Results from an Accelerated Pathway
Patients admitted for emergency treatment were excluded from this study. The ASSC is a combination of different parts. It involves a Stone Multidisciplinary Team (MDT) review of all emergency department referrals (<1 week), nurse telephone consult (NTC) within 12 days, subsequent combined radiographer and nurse clinic; with virtual shepherding through the Stone MDT.
The study lasted a period of 5 months during which 365 patients were included. The demographics were as follows: 73% were men, 27% were women. Age average was 48 years, youngest patients was 16 years old and the oldest was 91 years. As per ASSC pathway, 28% of the patients had immediate or elective extracorporeal shockwave lithotripsy (ESWL), the NTC contacted 39% of the patients to assess pain control, sepsis risk and discussion of management, 24% attended the Combined Clinic, 43% of patients required a Consultant Clinic review because initially stones were not visible on plain X-ray, had complex non-obstructing renal stones, and patients had no pertinent medical health problems. Results of this study showed that patients were evaluated at the Stone MDT within 1.9 days of referral (range 0 – 7 days) and the NTC within 12 days (average 7 days). Among patients who were assigned for the Combined Clinic, more than 90% were reviewed within 6 weeks with an average of 32 days. Surgery was necessary in only 8% of the patients, 14% were discharged after full evaluation, and 43% required a Consultant Clinic appointment.
This new accelerated pathway allowed evaluation of all patients within two weeks, thus decreasing the probability of kidney injury. Treatment was not delayed in patients with worsening kidney function and hematuria, and 87% of patients were treated within a period of 6 weeks. Higher satisfaction and relief was reported in all patients mainly because of early telephone consultation with education on stone natural history, advice on adequate pain relief, and titrating of a treatment pathway. Patients received a close follow up. Finally, the ASSC was able to reduce the risk of worsening renal obstruction, sepsis, need for auxiliary procedures and re-attendances to either emergency department or primary physicians which shows an improvement in clinical outcomes.
Presented by: Mudit Matanhelia, Bristol Urological Institute, Dept. of Urology, Bristol, United Kingdom
Written by: Faroukh El Khatib, MD, Research fellow, Department of Urology, University of California, Irvine at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.