An Audit on the Management of Adult Patients With Renal Colic Presenting to the Emergency Department.

Abstract

Introduction:  Renal colic is a common emergency department presentation requiring timely assessment, appropriate analgesia, and investigation. This clinical audit evaluated adherence to predefined standards for pain assessment, timely analgesia, investigations, imaging, and medication selection, and assessed changes in practice following a structured implementation phase.

Methods:  A retrospective, single-center, two-cycle clinical audit was conducted in an adult emergency department. The primary audit included 100 patients presenting between December 2020 and December 2024, and the re-audit included 100 patients presenting between March and September 2025, giving a total sample of 200 patients. Nine audit criteria were derived from the Royal College of Emergency Medicine (RCEM) and the National Institute for Health and Care Excellence (NICE) guidance. Following the primary audit, departmental education, audit feedback, an educational infographic, and a standardized renal colic analgesia pathway were implemented. Categorical outcomes were reported as frequencies and percentages and compared between audit cycles using two-sided Chi-square or Fisher exact tests, as appropriate.

Results:  First-line nonsteroidal anti-inflammatory drug (NSAID) administration increased from 39/100 patients (39.0%) in the primary audit to 60/100 patients (60.0%) in the re-audit, representing an absolute increase of 21.0 percentage points (95% CI: 7.5-34.5). This difference was statistically significant (χ²(1, N = 200) = 8.00; p = 0.005). Avoidance of first-line opioid administration increased from 89/100 patients (89.0%) to 94/100 patients (94.0%); however, this difference was not statistically significant (χ²(1, N = 200) = 1.03; p = 0.310). Pain-score documentation, timely analgesia, urine dipstick testing, laboratory investigations, computed tomography (CT) imaging, and avoidance of antispasmodic medication remained broadly consistent between the two audit cycles.

Conclusion:  Following implementation of a standardized renal colic pathway, departmental education, an educational infographic, and audit feedback, first-line NSAID use increased significantly and first-line opioid use decreased. Other key measures of assessment, investigation, and analgesic care remained generally stable between audit cycles. These findings support the value of a structured departmental approach to promoting guideline-concordant analgesic prescribing and provide a basis for continued quality-improvement activity and future re-audit.