The ‘Emergency Stone Clinic’ – improving patient care: A collaborative, hospital-based quality improvement project

Abstract

Introduction & Aims: There is a current drive nationally to improve the management of acute ureteric colic. Management targets set by the British Association of Urological Surgeons (BAUS) include a 4-week target for the time from diagnosis-to-definitive management, or to clinic review in patients managed expectantly. The motivation to review our acute stone service stemmed from concerns that we did not have the capacity to consistently offer primary definitive treatment or timely clinic review to patients. We aimed to restructure our service using Plan-Do-Study-Act (PDSA) cycles to achieve the BAUS targets. Method: All patients diagnosed with a ureteric stone between March and September 2017 were reviewed as a baseline. Our strategy for improvement involved implementing an emergency stone clinic (ESC) model. This was developed through collaboration between the key stakeholders and centred on a weekly consultant-led specialist clinic designed to review and make early management decisions for all patients referred with a ureteric stone meeting pre-agreed criteria. Post-intervention data were collected between June 2018 and January 2019. To assess whether we were able to meet these targets during the COVID-19 pandemic, data were also collected between January 2020 and October 2020. Results: Time from CT diagnosis to clinic review reduced from 77 to 9 days. Patients seen within 4 weeks of diagnosis improved from 2.9% to 90.5%. Of those requiring a procedure, the percentage receiving a primary intervention increased to 72.1%. Emergency stent insertion was reduced from 69% to 27.9%. The rate of patient re-presentation to A&E reduced from 3.0 to 1.6 episodes/month. The percentage receiving their definitive procedure within 4 weeks improved from 26.2% to 51.2% in the first post-intervention cycle and remained at 54.5% during the pandemic period. Conclusions: Implementing the ESC model led to substantial improvements in patient care and significant progress towards achieving the BAUS management targets while reducing the burden on our Emergency Department.