A renal colic fast track pathway to improve waiting times and outcomes for patients presenting to the emergency department
Authors Al Kadhi O, Manley K, Natarajan M, Lutchmedial V, Forsyth A, Tabrett K, Betteridge J, Finch W, Hollis H
Received 31 March 2017
Accepted for publication 5 May 2017
Published 24 July 2017 Volume 2017:9 Pages 53—55
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 3
Editor who approved publication: Dr Hans-Christoph Pape
Omar Al Kadhi,1 Kate Manley,1 Madhavi Natarajan,1 Valmiki Lutchmedial,2 Abbi Forsyth,2 Kate Tabrett,2 Jonathan Betteridge,2 William Finch,3 Heinrich Hollis4
1Department of Urology, Norfolk and Norwich University Hospitals NHS Foundation Trust, 2Faculty of Medicine and Health Sciences, University of East Anglia, 3Department of Urology, 4Department of Emergency Medicine, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
Introduction: Renal colic is commonly encountered in the emergency department (ED). We validated a fast track renal colic (FTRC) initiative to decrease patient waiting times and streamline patient flow.
Method: The FTRC pathway was devised according to the National Institute for Health and Care Excellence clinical summary criteria for the management of patients with suspected renal colic. ED triage nurses use the pathway to identify patients with likely renal colic suitable for fast track to analgesia, investigation and management. Investigations, diagnosis and patient demographics were recorded for 1157 consecutive patients coded as renal colic at a single-center ED over 12 months.
Results: Three hundred and two patients were suitable for the FTRC pathway (26.1%), while 855 were seen by the ED clinicians prior to onward referral. Also, 83.9% of patients underwent computed tomography scan. In the FTRC group, 57.3% of patients had radiologically confirmed calculi versus 53.8% in the non-FTRC group (p=0.31). Alternative diagnoses among FTRC patients (2.6%) included ovarian pathology (n=1), diverticulitis (n=2) and incidental renal cell carcinoma (n=2), while 26.1% had no identifiable pathology. No immediately life-threatening diagnoses were identified on imaging. Computed tomography scans performed in the non-FTRC group identified two ruptured abdominal aortic aneurysms and alternative diagnoses (2.57%) including ovarian pathology (n=7), cholecystitis (n=2), incidental renal cell carcinoma (n=3) and inflammatory bowel disease (n=1); 31.2% identified no pathology. Time in ED and time to radiologist-reported imaging were lower for the FTRC group versus non-FTRC group (p<0.0001).
Conclusion: The FTRC pathway is a safe and efficacious method of reducing diagnostic delay and improving patient flow in the ED.
Keywords: renal colic, ureteric colic, fast track, pathway, patient flow
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