A Novel Electronic Health Record-Integrated Clinical Pathway for Nephrolithiasis: Development and Management Outcomes.

Abstract

Introduction: Acute renal colic from nephrolithiasis is a common condition in emergency departments (EDs). Variation in clinical management contributes to unnecessary opioid use, inadequate discharge planning, and repeat visits. To address these challenges, we implemented an electronic health record-integrated clinical pathway to standardize management. We aimed to enhance pain control, streamline discharge practices, and optimize overall ED patient care. This study evaluates the impact of this pathway on important nephrolithiasis management process measures.

Methods: This retrospective cohort study examined patients presenting with renal colic or ureteral stones at 9 EDs in a northeast health system between January 1 and December 31, 2023. Outcomes analyzed included utilization of opioid alternatives (eg, lower-dose ketorolac and IV lidocaine), 28-day tamsulosin prescription at discharge, and time to urology follow-up. Statistical methods included Mann-Whitney U tests, Pearson χ² tests, and logistic regression.

Results: Of 5733 patients, 585 (10.2%) were managed through the nephrolithiasis pathway, while 5148 received standard care. Pathway use increased administration of the recommended ketorolac dose (33.2% vs 26.8%, P = .006), intravenous lidocaine use (5.6% vs 0.8%, P < .001), and 28-day tamsulosin prescriptions (22.7% vs 6.8%, P < .001). Multivariate analysis identified pathway utilization as a significant predictor for each intervention (ketorolac 15 mg dose: OR: 1.37, 95% CI: 1.10-1.71, P = .004; IV lidocaine: OR: 6.54, 95% CI: 4.09-10.46, P < .001; tamsulosin: OR: 3.78, 95% CI: 2.97-4.79, P < .001).

Conclusions: The electronic health record-integrated nephrolithiasis pathway effectively promoted evidence-based pain management promoting nonopioid pain control and appropriate medical expulsive therapy.