Computed Tomographic Scans on Patients with Repeat Renal Calculi: A Pilot Study

Abstract

Patients at risk for repeat renal calculi presenting to the ED with symptoms similar to their previous episodes, are likely to be over-exposed to computed tomographic (CT) scans. With recurrence at fifty percent minimizing CT use in this population is imperative (Goertz & Lotterman, 2010). Studies indicate using urinalysis and alternative imaging methods are necessary to prevent increases in radiation exposure, cost and ED visit time.The purpose of the project was to decrease CT use by providing current evidence-based research to ED providers on the overuse of CT scans for patients with a history of renal calculi who present with symptoms comparable to previous episodes. Using the logical model, the project was a retrospective chart review. The study took place in Charlton Memorial Hospital's ED. Charts were reviewed of patients who had a history of renal calculi and presented to the ED with flank pain. Patients were excluded for age less than eighteen, recent surgery, and chronic renal failure and/or dialysis due to renal impairment at baseline. The pre-presentation chart review was to assess the need to decrease CT scan ordering in the given population. An informational session on current research was provided to the providers and a post presentation chart review was completed to evaluate if there was a subsequent decrease in CT ordering. The study proved using evidencebased research to educate providers could result in a decreased amount of CT scans ordered. CT scans were ordered, eighty percent pre-presentation and decreased to sixtyfive percent post.