Renal Colic Or Just A Pain In The Side For The Surgeon?: A Comparison Study Of General Practitioner Referrals Suggestive Of Renal Colic Under A Cross Cover System

摘要

With the advent of the European working time directive many hospitals are reducing junior doctors hours with cross cover between specialties. What effect does this have on patient care?An comparison study of 74 patients referred by general practitioners (GP) with symptoms suggestive of renal colic was undertaken over a 6 month period at the Royal Gwent Hospital, Newport, South Wales. Patients were admitted either under the cross covering general surgeons or the urologists and their treatment compared.The study shows that GPs are successful at diagnosing acute renal colic and that urologists are significantly better than the general surgeons at investigating and arranging follow up for these patients. We recommend that GPs should refer acute urological conditions to the urologists rather than a cross covering specialty. Introduction Many hospitals throughout Britain combine their emergency urology cover with another surgical specialty, often, general surgery. With the advent of the European Working Time Directive it will become increasingly more difficult for the smaller departments to provide independent twenty-four hour cover 1 . As a result, the junior doctors will be forced to cross cover specialties but what effect will this have on patient care 2 ? This audit was undertaken to assess the accuracy of General Practitioner (GP) referrals for presumed renal colic and to assess whether patients received the appropriate investigations and follow up under a cross cover system.Acute renal colic is a common, often recurrent condition with an annual incidence of one to two cases per 1000 and a lifetime risk of 3-5% in women and 10-20% in men 3 4 . A typical case presents with a sudden onset of severe unilateral flank pain radiating into the groin or genitals 5 . At the Royal Gwent hospital in Newport, acute urology referrals are assessed by the on-call urology / ENT Senior House Officer with the exception of renal colic which is dealt with by the general surgeons. It is well documented that symptoms suggestive of acute renal colic may represent a varied presentation of an acute surgical abdomen or a leaking abdominal aortic aneurysm 6 . However, some recurrent cases of proven renal calculi are referred directly to the urologists. Methods All GP referrals are made via a nurse practitioner and recorded in the Bed Management records at the Royal Gwent Hospital.The Bed Management log was used to identify all patients referred with the diagnosis of possible renal colic or loin to groin pain over a six-month period from August 2003 to February 2004. (Total 74 patients).The notes were examined and the diagnosis, investigations and follow-up were recorded. Results During the period August 2003-February 2004, 74 patients were admitted with loin to groin pain or possible renal colic. This averages three admissions per week. 73 sets of case notes were located and appraised.The patients were equally split 37 males and 37 females with an age range from 22years to 84 years and the median being 49 years.The local GPs were correct in diagnosing 40 cases of renal colic out of the seventy-three cases referred (54.8%). Of the 73 cases, 52 were referred to general surgery, whilst 21 were referred to the urologists. Intra venous Urogram (IVU) was used to confirm the 40 cases of renal colic were due to calculi. (Surgery 21/52 and urology 19/21).The 2 remaining urology referrals were: a urinary tract infection and a large renal cyst distorting the renal pelvis. Several diagnoses accounted for the remaining 31 general surgical referrals. These are illustrated in the pie chart, figure 1.