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No. 035. Assessing and improving the management of Urolithiasis in the emergency department. Doeuk Norbert * , Kwok Titus ** , Al- Shawi Modher *, Sprott Philip* . * Royal Newcastle Hospital. ** Canterbury Hospital. oyal Newcastle Hospital. ** CanterbuHo. Aim
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Assessing and improving the management of Urolithiasis in the emergency department
Urolithiasisrepresents a large proportion of emergency referrals to the urology team. From personal experience, much time and resources are wasted and serious consequences to patients have resulted due to inappropriate management and referrals. This study aims to assess the level of knowledge on management of urolithiasis and whether a focused information pamphlet may help in improving this in the emergency department.
A 23 point questionnaire and a pamphlet entitled “ED Guide to Urolithiasis” (Appendix) were designed. The study was randomised to two groups across multiple centres (Royal Newcastle, Canterbury and Royal Prince Alfred Hospitals). This was done by a flip of a coin, and each participant was assigned to either the control or intervention group. The control group did not receive a pamphlet while the intervention group received the pamphlet to read prior to answering the questionnaire.
The planned sample of approximately 70 patients provided 80% power to detect a minimal difference of 2 points in overall score between the two groups. This sample size was calculated by assuming an improvement of at least 3 points in the interventional group compared with the control group, with a two-sided significance level (alpha) of 0.05. The means for the overall score of each group were compared using an unpaired Student T test. Responses to each individual questions were compared between the two groups using Fisher’s exact test.
There were 72 participants with 40 in the control group and 32 in the intervention group. There was no difference in the proportion of junior (intern, RMO, SRMO) and senior staff (registrar, consultant) in the two groups (P=0.46). Overall scores on the questionnaire averaged 13.7/23 correct answers in the control group and 16.9/23 correct answers in the intervention group. This difference was statistically significant (P<0.0001, 95% CI 1.838 to 4.625). Responses to key aspects of urolithiasis management also improved significantly with the pamphlet as shown in Table 1.
Table 1 – Responses to key aspects of urolithiasis management
The majority of responses to the remaining questions (Table 2) showed a trend towards a more correct answer in the intervention group but these were not statistically significant.
The information pamphlet designed for this study, proved to make a significant impact on improving responses among emergency doctors to a questionnaire addressing important aspects of management of urolithiasis in the emergency setting. In addition, the majority of participants found the study to be a useful learning experience.
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