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Introduction: We implemented an acute care urology (ACU) model at a large Canadian community hospital to determine the impacts on safe and timely care of patients with renal colic. The model includes a dedicated ACU surgeon, a clinic for emergency department (ED) referrals, and additional daytime operating room blocks for urgent cases. Methods: We conducted a chart review of 579 patients presenting to the ED with renal colic. Data was collected before (pre-intervention, September to November 2015) and after (postintervention, September to November 2016) implementation of the ACU model. Secondary methods of evaluation included surveying patients and 20 ED physicians to capture subjective feedback. Results: Of the 579 patients presenting with renal colic,194 were diagnosed with an obstructing kidney stone and were referred to urology for outpatient care. The ED-to-clinic time was significantly lower for those in the ACU model (p<0.001). Furthermore, the ACU clinic resulted in significantly more patients being referred for outpatient care (p=0.0004). There was also higher likelihood that patients would successfully obtain an appointment post-referral (p=0.0242). The number of after-hours and weekend surgeries decreased significantly after dedicated ACU daytime operating room (OR) blocks were added in Sep 2015 (p<0.0001). All surveyed patients rated the care as either “excellent” or “very good,” and all physicians believed the ACU model has improved patient care. Conclusions: The ACU model has shown benefit in ensuring timely followup for ED patients, reducing use of after-hour OR time, and improving patient and physician satisfaction.

Background Severe malaria is associated with multiple organ dysfunction syndrome (MODS), which may involve the gastrointestinal tract. Methods In a prospective cohort study in Uganda, we measured markers of intestinal injury (intestinal fatty-acid binding protein, I-FABP, and zonula occludens-1, ZO-1), and microbial translocation (lipopolysaccharide binding protein, LBP, and soluble complement of differentiation 14, sCD14) among children admitted with malaria. We examined their association with biomarkers of inflammation, endothelial activation, clinical signs of hypoperfusion, organ injury, and mortality. Results We enrolled 523 children (median age 1.5 years, 46% female, 7.5% mortality). I-FABP was above the normal range (≥400 pg/mL) in 415/523 patients (79%). I-FABP correlated with ZO-1 (ρ=0.11, p = 0.014), sCD14 (ρ=0.12, p = 0.0046), as well as markers of inflammation and endothelial activation. Higher I-FABP levels were associated with lower systolic blood pressure (ρ= -0.14, p = 0.0015), delayed capillary refill time (ρ= 0.17, p = 0.00011), higher lactate level (ρ= 0.40, p &lt; 0.0001), increasing stage of acute kidney injury (ρ= 0.20, p = 0.0034), and coma (p &lt; 0.0001). Admission I-FABP levels ≥5.6 ng/mL were associated with a 7.4-fold higher relative risk of in-hospital death (95%CI 1.4-11, p = 0.0016). Conclusion Intestinal injury occurs commonly in children hospitalized with malaria and is associated with microbial translocation, systemic inflammation, tissue hypoperfusion, MODS, and fatal outcome.