Impact of Creating a Stone Center on Urologic Care Coordination for Urolithiasis
Ariana Matz, MD1, Ashley Bodamer, MPA2, Bethany Buckridge, MSN, RN2, Tara McLaughlin, PhD3, Ilene Staff, PhD3, Joshua Stein, MD4.
1University of Connecticut School of Medicine, Farmington, CT, USA, 2Tallwood Urologic and Kidney Institute, Hartford, CT, USA, 3Hartford Hospital, Hartford, CT, USA, 4Hartford Healthcare, Hartford, CT, USA.
Background: Urolithiasis is one of the most common urologic conditions with prevalence rates in North America ranging from 7%-13%. It is a significant burden to the healthcare system, with estimates that total cumulative costs for managing patients with urolithiasis is $2.1 billion representing $490 million in emergency department spending alone.Entry points for stone patients to urology include the emergency department, primary care, urgent care, nephrologists, and other urologists. Our institution previously lacked a system-wide process for streamlining handoffs of stone patients from the Emergency Department to Urologists. Given the burden that urolithiasis places on patients and the healthcare system, the institution created a Stone Center designed to leverage a coordinated team of nurse navigators to effectively identify patients with urolithiasis and to triage them to urologic care. This is the first such stone center established in the state of Connecticut which triaged its first patient in 2021 and has since triaged 7,706 patients. Methods: Our team of nurse navigators review all Emergency Department visits related to a urolithiasis diagnosis from the previous 24 hours and categorize each patient as emergent, urgent, or elective based on pre-defined clinical data (fevers, solitary kidney, obstructing stone, etc.). Patients are contacted and scheduled for an appointment within an appropriate time frame based on established guidelines (same day, within one day, or within one week respectively). The collected data from patient electronic medical records diagnosed with urolithiasis are entered into a QI dashboard. The dashboard follows their urologic care with the institution through consultation, surgery, follow up, and any related encounter.Results: The emergency department coordination rate (defined as diagnosis to urology less than 14 days), improved from 17% to 38% from FY 18 (baseline) to FY22 (Figure 1). Between February, 2022 and January, 2023, at least 90% of patients were offered appointments within their respective appropriate timeframes in all but one month (Figure 2). Office stone visits increased 14% (4,556 to 5,203) from FY22 to FY23 (Figure 3). Additionally, stone surgical volume increased 18% from 960 surgeries in FY22 to 1,129 in FY23(Figure 4).Conclusion: The establishment of a Stone Center within a large health care system is an effective tool to improve coordination of care for patients diagnosed with urolithiasis in the emergency department. This has increased overall office stone visits and stone surgeries performed in our institution, which is beneficial to patients, urologists, and the entire health care system. . 
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