Choosing Wisely audit: CT KUB ordering in emergency department renal colic presentations.

OBJECTIVE: Our aim was to safely reduce unnecessary CT KUBs (kidneys, ureters, bladder) in patients with renal colic. METHODS: This was a before and after intervention observational study of 74 patients in April 2023 and 57 patients in October 2023. RESULTS: Seventy-five per cent of patients with suspected renal colic underwent a CT KUB in the pre-audit period. Following education, an update in the ED Renal Colic Policy, electronic medical record ordering and short stay pathway, a re-audit was undertaken in October 2023 resulting in an absolute reduction of 15% of CT KUBs ordered. CONCLUSIONS: Audit interventions can reduce unnecessary CT KUBs in renal colic.

Choosing Wisely audit: Blood gas ordering in the emergency department.

OBJECTIVE: Our aim was to reduce unnecessary blood gases to improve patient flow, reduce false positives and reduce unnecessary treatments. METHODS: This was a retrospective, single-centre audit of 100 patients in June 2022. RESULTS: There were approximately 45 blood gases per 100 ED presentations. Following education and poster reminders, a re-audit was undertaken in October 2022, resulting in a reduction of 33% of blood gases ordered. CONCLUSION: We have found that many blood gases are ordered for patients who are not critically unwell, and whose disposition was not affected by their result.

Population-based linkage of health records to detect urological complications and hospitalisation following transrectal ultrasound-guided biopsies in men suspected of prostate cancer.

BACKGROUND: Transrectal ultrasound-guided prostate biopsy is a common urological procedure with known complications. We determined the urological complication and 30-day hospital admission rate in a population-based cohort using unique identifier and deterministic methodology of record linkage. METHODS: 715 men who underwent a transrectal ultrasound-guided biopsy in Tayside region of Scotland between April 2007 and September 2011 were identified from hospital records using their unique Community Health Index Number. Multiple hospital electronic databases (Central Vision, Insite, Wisdom, and TOPAS) and departmental-based resources (morbidity and mortality records, daily ward electronic records) were linked to estimate urological complications (urinary tract infection, urinary retention, haematuria) and rates of hospital admission. Cross-validation of information was obtained by searching a drug dispensing information network and microbiology database for infective complications. The hospital admission rate was compared for two different prophylactic antibiotic regimens used during the study period. RESULTS: Of the 715 men who underwent transrectal ultrasound biopsy, 386 (53.9 %) were diagnosed with prostate cancer and 329 (46.1 %) were found to have benign histology. The hospital admission rate for urological complications within 30 days of the procedure for men without cancer was 1.95 % (14/715). The 30-day hospital admission rate was not different for different regimens of prophylactic antibiotics. There were 50 (6.99 %; 50/715) urine cultures requested to the microbiology department within 30 days of procedures; out of which 20 (2.79 %; 20/715) were positive. Most of these were generated from general practice requests. Eight blood cultures obtained within the same period were all negative. Eleven patients (1.7 %) presented with urinary retention during the same period and required indwelling catheterisation. None of them had any surgical procedure. Validation of electronic record linkage against telephonic questionnaires by specialist nurse showed a high reliability of the methodology (κ = 0.91). CONCLUSION: High quality validated record linkage of cohort data in the present study using a unique identifier, protocol-based procedure and antibiotic prophylaxis showed that hospitalisation following TRUS biopsies occurs in less than 2 % of patients. However, a significant number of patients report to primary care, and centrally held records based on coding alone could underestimate the true incidence of complications.