Emergency ureteric lithotripsy – Improving clinical care in the GIRFT era

Objective: Emergency ureteric stone treatment with lithotripsy is a key topic in Urology. This study describes the process of change in this unit to develop protocol-led quality care for patients with obstructing ureteric stones. Subjects/patients (or materials) and methods: A retrospective series of 675 consecutive patients undergoing emergency ureteric stone lithotripsy. Treatment data, times from referral to treatment completion and outpatient follow-up by endourologist are analysed. Data are reviewed over a 4-year period while protocol-led care was introduced. Results: This study demonstrates significant improvement in timely patient management. In 2017, the median time from referral to post-treatment review was 147 days. With the introduction of the protocol-led booking system, the median time from referral to post-treatment review was reduced to 14 days. Improvements in evidence-based shock wave delivery and clinical coding are demonstrated. Conclusion: This study demonstrates improvement in patient care through timely booking of lithotripsy treatment and follow-up. Barriers to improving care include IT support and changing established practice. Ongoing metrics for emergency ureteric lithotripsy should include the time taken from referral to post-treatment clinical review by an endourologist. Level of evidence: 4