Development and Implementation of an Evidence-Based Electronic Request Bundle for Metabolic Screening in Patients With Urinary Tract Calculi

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Introduction Kidney stone disease is a global health issue, with a well-known high recurrence rate after a first stone episode. Metabolic screening is a cost-effective tool for identifying patients at risk of recurrence due to a secondary disease. Our study aimed to assess compliance in a District General Hospital (DGH) and lay out a framework for the implementation of an electronic request bundle to improve screening levels in line with National Institute for Health and Care Excellence (NICE) guidelines. Methods A retrospective, cross-sectional study was conducted on 67 eligible patients, presenting with nephrolithiasis between May 2023 and July 2023. The percentage undergoing metabolic screening on admission was recorded and compared against previous Trust data. Clinical staff were surveyed to develop a streamlined electronic bundle, which was then implemented across the Trust collaboratively with Unity EPR engineers and senior clinical and non-clinical management. Results Thirty (47.8%) eligible patients had serum calcium levels measured on admission, and 25 (37.3%) patients had serum urate measured - similar screening levels to that collected during previous audits in the same Trust. Of the 30 surveyed staff, 12 (40.0%) reported they would routinely check serum urate and 15 (50.0%) serum calcium in renal stone presentations. In total, eight months of stakeholder meetings were required to effectively develop and deploy a new electronic requesting bundle, aiming to increase metabolic screening levels at the Trust. Discussion Adherence to NICE guidelines in renal stone patients at this DGH was significantly below the recommended standards of care. Identifying intervention points, surveying staff, and working with key stakeholders allowed for the integration of a metabolic screening tool. This study provides an effective framework for the development and sustainable implementation of an electronic requesting bundle, which can be modeled healthcare-wide.

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