To evaluate the adherence of clinical practices with the recommendations outlined in the National Institute for Health and Care Excellence (NICE) guidelines and Getting It Right First Time (GIRFT) document for ureteric stone management. ​To identify areas for improvement in clinical practice. ​

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Retrospective Audit . 1st Cycle : We reviewed 89 adult patients (16 years and older) that were admitted to the urology team at East Surrey Hospital, between 1st August 2023 and 30th November 2023 (inclusive). ​
2nd Cycle: 65 patients have been reviewed (16 years and older) from 1st of July 2024 to 30th of September 2024. ​
Documentation from Powerchart notes and ward lists were reviewed, focusing on the management and treatment of acute ureteric stones referred from A&E to Urology oncall team . ​

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Key improvements between cycles were observed. Serum calcium checks increased from 47% to 66%, and dietary advice from 17% to 72%. NSAID administration remained stable (70% to 67%). Conservative management rates dropped from 65% to 46%, with reduced failure rates (38% to 23%) and more patients receiving urgent treatment within 48 hours (35% to 53%). Stent insertions without clear sepsis indications declined from 83% (20/24) to 57% (12/21). Lost follow-ups post-hot clinic fell dramatically from 16 in Cycle 1 to 1 in Cycle 2. Follow-up after stent insertion also improved—2 patients were missed in Cycle 1, but none were lost in Cycle 2. Notably, 4 patients who received stents without documented indication were readmitted with complications.

Overall, these findings suggest that interventions from the first cycle's feedback likely improved patient management
practices, particularly in metabolic workup, patient counseling, and judicious use of stenting. This audit supports further
adherence to these revised practices to maintain quality care and optimize outcomes.​

The audit demonstrated marked improvement in adherence to national guidelines, particularly in basic patient management and decision-making for stent placement. However, limitations remain in urgent surgical capacity despite the establishment of a hot URS theatre, primarily due to staffing and CEPOD access. Further improvements can be achieved by implementing a formal care pathway, strengthening follow-up systems, and introducing incident reporting (Datix or iPhase) for delays in definitive management. A re-audit is planned within 6–12 months to track sustained progress.

https://bursturologycollaborative.github.io/ #calculator1?
https://www.nice.org.uk/guidance/ng118/c hapter/Recommendations#surgical- treatments-including-shockwave- lithotripsy?
https://www.gettingitrightfirsttime.co.uk/w p-content/uploads/2021/12/Urology_2021- 12-10_Guidance_Acute-stones.pdf?