E CURRY1, L LLOYD1, C JORDAN2, S LOEFF3, M RICE1, J COLLINS1
1Auckland City Hospital, Grafton, New Zealand, 2University of Auckland, Auckland, New Zealand, 3Universitair Medisch Centrum Groningen, Groningen, Netherlands
Aim: To audit and improve the management of patients with kidney stones presenting to Auckland City Hospital
Methods: A retrospective audit of patients presenting to Urology with acute kidney stone events from July 2014 – July 2015 was undertaken. This demonstrated that most patients at risk for recurrent stones were not subsequently screened metabolically or referred to nephrology. A stones clinic was established and a further audit was undertaken.
Results:1328 stone event were recorded from July 2014 – July 2015. 56% of patients were classified as being at high risk for further events. Only 14% of high-risk patients had any 24 urine collections performed and fewer than 5% saw a dietician.Following this a metabolic stone assessment clinic was developed. Set referral criteria and referral processes were implemented including the development of standard 24 hour urine collection forms, patient information and instruction sheets and an Emergency department referral form. The clinic was audited from September 2016 – September 2017. A total of 52 patients were seen over this time with appointment numbers showing a progressive rise over time. 34.8% of patients had complete blood tests carried out and 30% had the recommended three 24 hour urine collects prior to the first review, the remainder completed investigations after the first review. 92% of patients received dietary advice and 21.2% were prescribed medication.
Conclusions: The introduction of a standard process has resulted in major improvement in the assessment and management of high-risk stone formers. Ongoing efforts are required to ensure that all patients at risk for recurrent stone formation are referred. New strategies have been implemented and a further audit of practice and results is planned.
Dr Elizabeth Curry is a general nephrologist at Auckland City Hospital. She has interests in kidney stones, CKD and haemodialysis. She has been involved the set up of a new metabolic stone assessment clinic in Auckland, New Zealand.