Saidani Zakaria, Ganapathi Shaswath, Malik Salim S, Khan Fahd
Urology, Sandwell and West Birmingham Hospitals, Birmingham, GBR.
Cureus. 2024 Nov 11;16(11):e73448. doi: 10.7759/cureus.73448. eCollection 2024 Nov.
Introduction Kidney stone disease is a global health issue, with a well-known high recurrence rate after a first stone episode. Metabolic screening is a cost-effective tool for identifying patients at risk of recurrence due to a secondary disease. Our study aimed to assess compliance in a District General Hospital (DGH) and lay out a framework for the implementation of an electronic request bundle to improve screening levels in line with National Institute for Health and Care Excellence (NICE) guidelines. Methods A retrospective, cross-sectional study was conducted on 67 eligible patients, presenting with nephrolithiasis between May 2023 and July 2023. The percentage undergoing metabolic screening on admission was recorded and compared against previous Trust data. Clinical staff were surveyed to develop a streamlined electronic bundle, which was then implemented across the Trust collaboratively with Unity EPR engineers and senior clinical and non-clinical management. Results Thirty (47.8%) eligible patients had serum calcium levels measured on admission, and 25 (37.3%) patients had serum urate measured - similar screening levels to that collected during previous audits in the same Trust. Of the 30 surveyed staff, 12 (40.0%) reported they would routinely check serum urate and 15 (50.0%) serum calcium in renal stone presentations. In total, eight months of stakeholder meetings were required to effectively develop and deploy a new electronic requesting bundle, aiming to increase metabolic screening levels at the Trust. Discussion Adherence to NICE guidelines in renal stone patients at this DGH was significantly below the recommended standards of care. Identifying intervention points, surveying staff, and working with key stakeholders allowed for the integration of a metabolic screening tool. This study provides an effective framework for the development and sustainable implementation of an electronic requesting bundle, which can be modeled healthcare-wide.
引言
肾结石疾病是一个全球性的健康问题，首次发作后复发率很高，这是众所周知的。代谢筛查是一种经济有效的工具，可用于识别因继发性疾病而有复发风险的患者。我们的研究旨在评估一家地区综合医院（DGH）的依从性，并制定一个实施电子申请包的框架，以根据英国国家卫生与临床优化研究所（NICE）的指南提高筛查水平。
方法
对2023年5月至2023年7月期间67例符合条件的肾结石患者进行了一项回顾性横断面研究。记录入院时接受代谢筛查的患者百分比，并与该信托机构以前的数据进行比较。对临床工作人员进行了调查，以开发一个简化的电子包，然后与Unity EPR工程师以及高级临床和非临床管理人员合作，在整个信托机构实施。
结果
30例（47.8%）符合条件的患者入院时进行了血清钙水平检测，25例（37.3%）患者进行了血清尿酸检测，筛查水平与该信托机构以前审计期间收集的水平相似。在接受调查的30名工作人员中，12名（40.0%）报告说，他们会在肾结石患者就诊时常规检查血清尿酸，15名（50.0%）会检查血清钙。总共需要八个月的利益相关者会议来有效地开发和部署一个新的电子申请包，旨在提高该信托机构的代谢筛查水平。
讨论
该地区综合医院肾结石患者对NICE指南的依从性明显低于推荐的护理标准。确定干预点、调查工作人员并与关键利益相关者合作，使得能够整合一种代谢筛查工具。本研究为开发和可持续实施电子申请包提供了一个有效的框架，该框架可在全医疗范围内进行效仿。
