Standard of outpatient management of renal colic

Abstract

The aim of the research was to assess the standard of emergency outpatient management of renal colic at Khyber Teaching Hospital, Peshawar, Pakistan. A retrospective clinical audit of 197 randomly selected outpatients presenting with renal colic received and treated at the emergency department of Khyber Teaching Hospital, Peshawar, was carried out over a 1-year period from June 2014 to June 2015. Data were collected from the outpatient sheets of selected patients. The management they received was compared with the Royal College of Emergency Medicine’s (RCEM) guidelines for the management of renal colic. The results of this research showed that management fell short of RCEM guidelines for pain score on admission, which was not assessed or recorded in any of the 197 cases. Administration of analgesia for severe pain within 20, 30 and 60 minutes of admission was better than RCEM guidelines by 9%, 25% and 2%, respectively. It fell short of RCEM guidelines for moderate pain at 30 and 60 minutes by 69.9% and 19.1%, respectively. Re-evaluation of analgesia for severe pain exceeded RCEM guidelines by 10%, but fell short of the guidelines for moderate pain by 13%. Patients not receiving analgesia should be documented in all cases but, in this respect, the audit fell short of the guidelines by 9.1%. A full blood count and urea and electrolyte levels were assessed in only 73 (37.1%) and 8 (4.1%) cases, respectively, and fell short of the guidelines by 62.9% and 95.9%, respectively. None of the patients qualifying for assessment for abdominal aortic aneurysm (AAA) was investigated or assessed for the illness and the audit fell short of the RCEM guidelines in all 47 cases (23.9%). Our conclusions are that current practices partially complied with standards set by the RCEM guidelines for the management of renal colic. This should be addressed by presentations to doctors and nurses at the emergency outpatient department on RCEM guidelines and the findings of the present audit. Categories that fell short of the RCEM guidelines included pain score on admission; re-evaluation for moderate pain; documentation in all aspects of RCEM guidelines, including reasons for not receiving analgesia; performing RCEM laboratory investigations for all cases of renal colic; and assessment and management of cases qualifying for abdominal aortic aneurysm. Posters detailing the RCEM guidelines have been set up in the emergency