Presentation Authors: Nina Mikkilineni*, David Weiner, Gen Li, Ojas Shah, Kelly A. Healy, New York, NY
Introduction: The acute care surgery model was introduced to facilitate timely evaluation and treatment of patients presenting to the emergency room (ER) with acute conditions. While this model has been rapidly adopted in General Surgery, there is a paucity of data in Urology. We sought to examine the impact of our new Acute Care Urology (ACU) service on timeliness of care for acute stone patients. The ACU team consists of five rotating physicians on a daily basis who triage acute consults from the ER and inpatient wards at a large tertiary referral center.
Methods: We conducted a retrospective review of all patients who underwent ureteral stent placement before (2012, pre-ACU) or after (2017, post-ACU) implementation of our ACU service. Only patients presenting to the ER and evaluated by the Urology team for an acute stone episode were included. Baseline demographic characteristics were recorded. The primary outcome was time from urological consult and/or stent placement to definitive stone intervention. Secondary outcomes included readmission rate (including repeat ER presentation) and lost to follow-up rate. Statistical analyses included Chi-Square, Cox proportional hazards model, and logistic regression with p < 0.05 considered significant.
Results: A total of 139 patients met inclusion criteria (68 pre-ACU, 71 post-ACU). Patient demographics were similar between both groups. On univariate analysis, time to definitive stone treatment was significantly shorter in the post-ACU group compared to the pre-ACU group (median 18.5 vs. 31.5 days, p=0.015). There were no statistically significant differences between pre-ACU and post-ACU groups in readmission (19.1% vs. 15.5%, p=0.70) or lost to follow-up rates (17.6% vs. 21.1%, p=0.76). On multivariate analysis including age, gender, insurance status, primary language (English vs. Non-English), and ACU status, only post-ACU status was associated with significantly shorter time to intervention (HR 1.55, 95% CI: 1.02-2.36, p=0.041). For readmission rate, only younger age was associated with higher readmission rates (OR 0.94, 95% CI: 0.90-0.98, p=0.004). There were no significant differences between patients lost to follow-up and those who returned.
Conclusions: Implementation of a dedicated ACU service decreased time to definitive stone treatment. Additionally, there was a clinically meaningful decrease in readmissions with an ACU service. Future studies are needed to evaluate its impact on healthcare costs, patient satisfaction, and other acute urological conditions amenable to this model.