Renal Colic AuditRenal Colic Audit

Jake TurnerJake Turner

Mirna Al-KhouriMirna Al-Khouri

Lincoln County HospitalLincoln County Hospital

ObjectivesObjectives

To ensure correct assessment and To ensure correct assessment and managementmanagement

To avoid misdiagnosis of potentially To avoid misdiagnosis of potentially life threatening conditionslife threatening conditions

To ensure appropriate follow up To ensure appropriate follow up To measure compliance with To measure compliance with

guidelinesguidelines

Audit standardsAudit standards

College of Emergency Medicine College of Emergency Medicine guidelinesguidelines

‘‘Management of adult patients with Management of adult patients with renal colic’renal colic’

MethodologyMethodology

A retrospective audit of 50 A retrospective audit of 50 consecutive cases of suspected renal consecutive cases of suspected renal colic between 1st August 2010 and colic between 1st August 2010 and 31st January 2011 who presented to 31st January 2011 who presented to the ED, Lincoln County Hospitalthe ED, Lincoln County Hospital

Criteria – Audit inclusionsCriteria – Audit inclusions

Adults over 18 years of age onlyAdults over 18 years of age only

Diagnosed cases of renal colic on Diagnosed cases of renal colic on clinical judgement or radiological clinical judgement or radiological investigationinvestigation

Cases of moderate to severe painCases of moderate to severe pain

Criteria – Local guidelinesCriteria – Local guidelines

AnalgesiaAnalgesia 1st line – 1st line – MorphineMorphine IV/POIV/PO or or Diclofenac Diclofenac PO/PRPO/PR 2nd line – 2nd line – CodeineCodeine containing oral analgesics containing oral analgesics

Initial radiological investigationInitial radiological investigation Uncomplicated – KUBUncomplicated – KUB Complicated – CT KUBComplicated – CT KUB

Exclusion of AAAExclusion of AAA Follow-upFollow-up

Uncomplicated – outpatient CT KUBUncomplicated – outpatient CT KUB Complicated – inpatient CT KUBComplicated – inpatient CT KUB

ConclusionConclusion

Poor administration and re-Poor administration and re-evaluation of analgesiaevaluation of analgesia

Variable utilisation of investigations Variable utilisation of investigations with poor use of X-ray KUB and FAST with poor use of X-ray KUB and FAST scan, and better use of blood tests scan, and better use of blood tests and urinalysis.and urinalysis.

An appropriate referral rate of 72%An appropriate referral rate of 72%

RecommendationsRecommendations

Educate the nursing staff regarding Educate the nursing staff regarding the current analgesia guidelines for the current analgesia guidelines for renal colic patientsrenal colic patients

Further education regarding the Further education regarding the required investigations for renal required investigations for renal colic, the re-assessment AND colic, the re-assessment AND documentation of pain scoresdocumentation of pain scores Presentation of audit resultsPresentation of audit results Providing a reference guide for the EDProviding a reference guide for the ED

Follow-up

Management

Investigations

Renal Colic ManagementRenal Colic ManagementRequirements in all patients presenting to the Requirements in all patients presenting to the

emergency departmentemergency department

• Urine dipstick• Xray KUB• Full Blood Count and Urea/Electrolytes• FAST scan to exclude AAA in everyone 60+ years of age

• Analgesia first line – PO/IV morphine or PO/PR diclofenac• Analgesia second line – Codeine containing oral analgesics

• Hospital admission:o Ongoing pain requiring morphineo Signs of infection (pyrexia, leucocytosis and urine dip)o Deranged U/E results

• GP to arrange outpatient KUB if uncomplicated renal colic