MP01-04 INNOVATION IN URETERAL STONE CARE DELIVERY AFTER EMERGENCY DEPARTMENT (ED) VISIT: MATCHED CONTROLLED STUDY.

Abstract

You have accessJournal of UrologyStone Disease: Epidemiology & Evaluation I1 Apr 2017MP01-04 INNOVATION IN URETERAL STONE CARE DELIVERY AFTER EMERGENCY DEPARTMENT (ED) VISIT: MATCHED CONTROLLED STUDY. Abdulrahman Alruwaily, Sapan Ambani, Steven Kronick, Gary Faerber, John Hollingsworth, William Roberts, and J. Stuart Wolf Abdulrahman AlruwailyAbdulrahman Alruwaily More articles by this author , Sapan AmbaniSapan Ambani More articles by this author , Steven KronickSteven Kronick More articles by this author , Gary FaerberGary Faerber More articles by this author , John HollingsworthJohn Hollingsworth More articles by this author , William RobertsWilliam Roberts More articles by this author , and J. Stuart WolfJ. Stuart Wolf More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.079AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We aimed to improve the care of patients who were discharged from our ED with ureteral stones by decreasing the time to definitive surgical treatment, reducing subsequent ED re-use, and minimizing the loss of follow-up after ED acute care, using a new model of care involving collaboration between the ED and Endourology Division. METHODS Starting March 1, 2015, automated email notifications were sent from our ED about all patients who were discharged from the ED with a diagnosis of ureteral stones. Among them, we determined those eligible for early surgical intervention using prospectively determined criteria (stone size = 5mm, persistent pain, signs of infection, or renal function deterioration) and an Endourology provider contacted eligible patient by phone to offer them early surgical intervention without an intervening clinic visit. We compared patients in the initial email intervention period with a control group who were discharged from the ED prior to initiation of the email program. We matched intervention and control patients 1:1 by stone size, location, and gender. We then fitted a Cox Regression model to examine for differences in time to surgery between two groups, which was our primary endpoint. In addition, we compared the groups in terms of the loss of follow-up and ED revisits. RESULTS We compiled a comparison group of total 72 patients who underwent the email intervention and standard care. The groups had comparable body mass index, previous stone history, and renal function (all p>0.20). The time to surgery was much shorter in the intervention compared to the control group (8 days vs. 29 days, respectively, p-value <0.001). The new intervention was also associated with decreased proportion of patients lost to follow up (8% vs. 42%, p-value =0.001) and returning to the ED (6% vs. 25%, p-value 0=0.02). After adjusting for baseline characteristics and surgeon, using the email intervention decreased the time to surgery by 5 times that of the control group (HR=4.9, p-value <0.0001). CONCLUSIONS An automated email notification program following by a phone call to offer early surgical intervention improved the quality of care for patients with ureteral stones by decreasing the time from ED to surgery, reducing the patient care burden on the clinic, minimizing loss of follow-up, and reducing ED revisits. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e2 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Abdulrahman Alruwaily More articles by this author Sapan Ambani More articles by this author Steven Kronick More articles by this author Gary Faerber More articles by this author John Hollingsworth More articles by this author William Roberts More articles by this author J. Stuart Wolf More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...