Improving the effectiveness of the emergency management of renal colic in a district general hospital: a completed audit cycle.
OBJECTIVE
To assess the current practice of emergency management of renal colic in a district hospital, review literature, implement new guidelines, and assess them.


METHODS
Data were collected about the use of analgesia, waiting time for intravenous urography (IVU), and admission status of patients presenting to the hospital with symptoms of renal colic over the period of three months. A literature search into the use of analgesia, imaging, and treatment was performed. Members of the involved departments were consulted and new guidelines developed and implemented. This was followed by further data collection over three months.


RESULTS
Seven of 14 patients were admitted. Five to wait for their IVU. Their average waiting time was 12.3 (SD 2.2) hours. Mainly intramuscular opioid analgesia was used. Literature recommended the use of diclofenac. Although computed tomography was favoured it was decided to continue to use IVU because of circumstances within the hospital. The literature recommended a cut off between conservative and surgical treatment at a calculus size of >4 mm. Existing policies of the relevant departments were obeyed and a training system for the junior doctors was introduced. Emergency department staff were encouraged to perform 3-film IVUs. After this, of 5 of 19 patients were admitted, only one of those to wait for an IVU. The average waiting time for an IVU was 4.1 (SD 0.96) hours. Rectal diclofenac was noted to be the drug of choice.


CONCLUSIONS
Coordination of efforts, interdepartmental communication, and a practical application of available literature has resulted in a significant improvement of effectiveness without affecting medical standards, workload, or resources. Accident and emergency senior house officers felt highly satisfied at being able to complete management from presentation to diagnosis and treatment. Interdisciplinary communication has to be continued to maintain smooth operation of the guidelines.
Kastner
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Department of Urology, East Surrey Hospital, Redhill, UK.ckastner@rcsed.ac.uk
Tagg
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D000701:Analgesics, Opioid / Q000008:administration & dosage; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D003085:Colic / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004008:Diclofenac / Q000008:administration & dosage; D004333:Drug Administration Routes; D004630:Emergencies; D004636:Emergency Service, Hospital / Q000592:standards*; D004638:Emergency Treatment / Q000592:standards*; D004739:England; D006760:Hospitalization; D006767:Hospitals, District; D006769:Hospitals, General; D006801:Humans; D007674:Kidney Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008485:Medical Audit; D008614:Meperidine / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D014850:Waiting Lists
D000701:Analgesics, Opioid; D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac; D008614:Meperidine