Category: Clinical Stones: Outcomes

MP31-10 - A closed loop audit of all emergency ureteric stent insertion within a large district-general hospital; Are patients waiting too long for further procedures and what is the morbidity related to stent-symptoms?

Sun, Sep 23
2:00 PM - 4:00 PM

Introduction & Objective : There is no current national gold standard within this area. Ureteric stents are thought to be safe up to 12 months post-insertion, however rates of stent encrustation increase dramatically after 3 months. Data taken from activity across eight specialist stone units in June 2015 revealed a 6 week readmission rate of 13.3%. Guidance was recently released by the British Association of Urological Surgeons (BAUS) proposing a target time of four weeks for review of all new patients with ureteric stones, and for definitive intervention in patients stented acutely.

Our aims were to retrospectively identify all patients undergoing emergency ureteric stent insertion within a given 6 month time-frame. To quantify the time elapsed until first definitive management, and to assess the number of re-presentations related to stent symptoms or complications.


Methods :

1st round data was collected between January 2016 - June 2016. All patients undergoing emergency insertion of a retrograde or antegrade ureteric stent were identified and details of initial insertion, time elapsed until definitive procedure, and incidence of representation to hospital recorded.


Interventions introduced within the department as part of the action plan included the implementation of the Boston Scientific Stent Register, the development and introduction of a stent education leaflet to be provided post-operatively, a target for all patients to receive a date for their second procedure prior to discharge, and a departmental consensus to aim for this to be within 12 weeks. The service was re-audited between March 2017 - September 2017.


Results :

Initial audit revealed median time-elapsed until definitive procedure to be 119 days (range 25-246); 3.2% of patients received a definitive procedure within 1 month, 26.4% within 3 months, 54.7% within 6 months. Representation rate was 41%.


Re-audit after intervention showed a reduction in median time-elapsed to 63 days (range 13-229); 15.6% of patients received a definitive procedure within 1 month, 68.8% within 3 months, 81.3% within 6 months. Representation rate was 30.6%.


Conclusions : We aim to continue improving our service by introducing a formal primary URS pathway, creating a 'hot clinic' to review all new patients, and utilising a stent ‘diary’ to allow easier view and management of patients awaiting a date for procedure. Within the department we will be aiming to try and meet the new targets recommended by BAUS. We will look to re-audit the service again at a future date as part of continuous review of our department's performance.

Edward Balai

Doctor
Barts Health NHS Trust
Somerset, England, United Kingdom

Christopher Bastianpillai

London, England, United Kingdom

Pallavi Pal

Consultant
Department of Urology, Whipps Cross University Hospital, London
London, England, United Kingdom

Stuart Graham

Consultant
Department of Urology, Whipps Cross University Hospital, London
London, England, United Kingdom

Umer H. Siddique

FY1 Doctor in Urology
Department of Urology, Whipps Cross University Hospital, London
Ilford, England, United Kingdom

Dr Umer Hayat Siddique BMBS (Hons), BMedSci, BSc (Hons) is a foundation doctor training in London's North East Thames Foundation School. Having worked in the Urology department at Whipps Cross Hospital in London, a part of the Barts Health NHS Trust, he is currently based in Intensive Care Medicine in Barking, Havering and Redbridge University Hospitals NHS Trust.