The National Institute for Health and Care Excellence (NICE) has recently published some Quality Standards to support the existing NICE Guidelines on the assessment and management of renal and ureteric stones.
Another name for renal stones is Kidney Stones.
Kidney Stones
Kidney stones are quite common. They affect around 1 in 10 people and most often affect people aged 30 to 60. They can develop in just 1 or both kidneys.
Some stones are small and can simply be expelled in your urine. However, larger stones can be incredibly painful and can result in kidney infections or kidney failure if not treated correctly.
Symptoms of kidney stones include abdominal pain that comes and goes (known as “renal colic”), blood in your urine, nausea and vomiting.
The Quality Standards
The newly published Quality Standards provide recommendations to healthcare providers as to how they can improve their standards to ensure they comply with the existing NICE Guidelines.
This is intended to improve patient quality of life and reduce the chances of the patient having to go back into hospital after being treated.
There are 5 areas covered in the Quality Standards:
- Diagnostic Imaging (Scans)
- Pain Management
- Timing of surgical treatment
- Metabolic Testing
- Dietary advice
Diagnostic Imaging (Scans)
NICE Guidelines state that patients with suspected renal colic should be offered a CT scan within 24 hours of being seen, unless there is a reason why this would be unsuitable (such as if the patient was pregnant).
This is to prevent delays in treatment that can cause renal function to decline, and also prevents patients being in pain for longer periods prior to diagnosis.
The Quality Standards state that GPs and Emergency Department doctors should be aware of referral pathways for CT scans and also ensure that CT scanning equipment and staff are available to perform the scans within 24 hours. Commissioners should ensure that their services have sufficient equipment and capacity to perform these scans.
Pain Management
NICE Guidelines state that patients with suspected renal colic should be offered non-steroidal anti-inflammatory drugs (NSAIDs) as first-line treatment.
NSAIDs are the most effective form of pain relief for renal colic and this therefore reduces the need for additional pain relief and reduces ongoing pain.
The Quality Standards state that GPs and Emergency Department doctors should offer NSAIDs as first-line treatment, unless it is unsuitable. Commissioners should ensure that services have written protocols in place for offering NSAIDs by any route as first-line treatment.
Timing of Surgical Treatment
NICE Guidelines state that patients with kidney stones and renal colic should have surgical treatment within 48 hours of diagnosis or readmission (coming back into hospital) if the pain is ongoing despite painkillers, or if the stone is unlikely to pass through urine.
Earlier surgery can make the surgery easier and more effective. It can also prevent prolonged pain and potential damage to the kidney.
The Quality Standards state that healthcare providers should ensure that referral pathways are in place so that patients can be referred for surgery within 48 hours of diagnosis or readmission. Commissioners should also ensure that emergency operating theatres and staff are available to perform the surgery in this timeframe.
Metabolic Testing
NICE Guidelines state that patients with kidney stones should have their serum calcium levels measured.
Measuring serum calcium levels is a simple way to identify any underlying conditions that may be causing the kidney stones.
The Quality Standards state that GPs and Emergency Department doctors should ensure they have systems in place to measure serum calcium levels.
Dietary Advice
NICE Guidelines state that patients with kidney stones should be given advice on diet and fluid intake.
This is because the best way to reduce the risk of recurrence of these stones is to make dietary changes.
The Quality Standards state that GPs and other healthcare professionals should give suitable advice to patients on what to eat and drink to reduce the risks of the patients developing kidney stones again.
How can we help
Our specialist Clinical Negligence team at Lester Aldridge have experience in dealing with claims relating to misdiagnosis or delays in diagnosis and treatment of kidney stones.
If you or anyone in your family has been affected by kidney stones and you have concerns about the treatment you received, our Personal Injury team can assist on 01202 786260 or online.enquiries@la-law.com.
