08:56am Thursday 21 September 2017

ER Patients Discharged After Kidney Stone Evaluation Likely to Return

In a study published online in the journal Academic Emergency Medicine, Duke researchers and their colleagues have identified multiple factors that correlate with repeat emergency room visits for kidney stones. The findings may provide physicians and patients with a blueprint for how to improve care for a condition that is both painful and costly.

“This is the first study that has looked at what happens to a large group of patients after they leave the emergency department,” said lead author Charles Scales, M.D., assistant professor of Surgery at Duke University School of Medicine. “Prior work in this area has really only looked at the processes of care during an emergency department visit, but not outcomes after patients go home.”

More than one million people visit the emergency department annually for kidney stones and that number is on the rise. 

“The prevalence of kidney stones has nearly doubled in the past 15 years,” Scales said. “This is likely related to the increasing obesity rates in the U.S. population and the diet and lifestyle of Americans today.”

In their retrospective study, Scales and colleagues analyzed data collected over two years from every emergency department visit in California. Using administrative information generated from more than 128,000 initial visits for a kidney stone, they were able to identify associations between patient-level characteristics, area health care resources, processes of care, and the risk of a repeat emergency department visit.

Symptoms that lead to patients returning include uncontrolled pain, severe vomiting leading to dehydration, or infections that coincide with kidney stones – conditions that can require an emergency operation. 

Repeat visits were more likely in areas where there are fewer urologists, indicating that access to specialized treatment might be able to prevent a return to the emergency room.

“We also found that those patients who had Medicaid or Medicare coverage were more likely than those privately insured to return to the emergency department,” Scales said. “This finding suggests that obtaining access to care may involve more than simply having insurance coverage.”

The researchers also examined whether the care patients received was associated with the risk of revisits. Patients who received lab testing to assess for systemic infection were less likely to return to the emergency department. 

“Although requiring further investigation, this finding suggests that the quality of care at that first visit may influence the risk of a second emergency department visit,” Scales said.

“Overall, our aim is to find ways to improve care for patients facing the excruciating pain of passing a kidney stone,” Scales said. “One solution may be better coordination between primary care and urology to treat patients so they do not have to seek care in a high-expense, high-acuity setting like the emergency department.”  

In addition to Scales, study authors from Duke include Li Lin, along with Christopher S. Saigal, Carol J. Bennett, Mark S. Litwin, Ninez A. Ponce, and Carol M. Mangione from the University of California, Los Angeles. 

The National Institute of Diabetes and Digestive and Kidney Diseases (HHSN276201200016C) and the National Library of Medicine of the National Institutes of Health provided support for this study. Scales was supported by the Robert Wood Johnson Foundation and the VA Office of Academic Affiliations through the VA/Robert Wood Johnson Clinical Scholars Program.  

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