(Watch the Presentation – Starts at 1h 36m)In a follow-up to his selection as an Improvement Scholar by the UNC Institute for Healthcare Quality Improvement (IHQI) last year, Dr. Dave Friedlander, Assistant Professor of Urology, and the Urology Department’s Co-Director of Quality Improvement, presented his work on renal colic care at the IHQI’s 2024 Symposium held on October 22, 2024. This symposium celebrated the work of clinician-led initiatives aimed at enhancing clinical effectiveness and patient safety across UNC Health.
Dr. Friedlander’s project, titled “Improving Pathways of Care Following Emergency Department Discharge for Renal Colic,” focused on improving the timeliness and quality of follow-up care for patients discharged from the Emergency Department (ED) with acute renal colic, commonly known as kidney stones. Renal colic is a condition that affects approximately one in ten adults in the U.S. and is associated with significant pain, healthcare costs, and potential complications if not managed promptly and effectively. The goal of Dr. Friedlander’s project was to standardize the discharge process and improve access to ambulatory follow-up, which can reduce unnecessary ED revisits and optimize patient outcomes.
Outcomes and Impact
Since the project’s launch, Dr. Friedlander and his team have implemented a series of evidence-based interventions, including a triage protocol that categorizes renal colic patients by risk level (low, moderate, or high). This protocol ensures that patients receive appropriate follow-up care based on their risk. For instance, low-risk patients are advised to follow up in a few weeks, while high-risk patients are connected with urology specialists for urgent follow-up. Additionally, customized discharge instructions in both English and Spanish have been incorporated into the After Visit Summary (AVS) for renal colic patients, helping patients better understand their condition and the importance of follow-up.
Data from the pilot phase indicate promising results. The project reduced the median time from referral to urology appointment and significantly lowered 30-day ED revisit rates, a critical measure of improvement. For instance, the referral process has been streamlined, reducing wait times from an average of 49 days to closer to the target of 20 days, and 30-day ED revisit rates have decreased further below the national benchmarks. These improvements underscore the effectiveness of standardized care pathways in reducing fragmentation and improving the overall value of care for patients with renal colic.
Dave Friedlander, MD, MPH
Assistant Professor of Urology
A Broader Vision for Multidisciplinary Care
Dr. Friedlander’s project aligns with UNC Health’s commitment to quality and value-based care. His multidisciplinary approach brings together resources from the Department of Urology, Emergency Medicine, and Internal Medicine, as well as support from the UNC Health Alliance. Under the guidance of mentors like Dr. Matthew Nielsen, Dr. Friedlander has designed an ambitious model of care coordination that could serve as a blueprint for managing other complex conditions.
Dr. Friedlander’s work has led to renal colic being selected as one of the inaugural conditions to be translated into an AgileMD pathways project. This would seamlessly integrate the treatment algorithm into a point-and-click solution embedded within UNC’s Electronic Health Record. This integration would support the automated tracking of high-risk patients, ensuring that they receive timely outpatient evaluations. The team is also exploring the potential for an expanded urgent urology clinic to accommodate the increased demand for rapid follow-up.