Computerized tomography scan of the kidneys, ureters and bladder (CT KUB) is an excellent imaging modality to assess for urinary stones, however it uses lower radiation power thus may not be able to detect other abnormalities.

Many referrals lacked blood documentation of microscopic haematuria. We wanted to improve the following:

• Ensure patient safety by requesting CT KUB in patients with blood documentation
• Narrow clinical differentials to ureteric stones

• Retrospective study: All adult patients referred for CT KUB: two rounds of retrospective studies done.
• Period: 2nd Audit from 15/08/2021 to 15/09/2021 and 1st Audit from 01/04/2021 to 01/06/2021. Sample size 42 and 48 respectively.
• Inclusion: Adult patients referred to rule out acute kidney stones, no exception.
• Target: Adult patients referred to rule out acute kidney stones.

• Results of 1st audit round: 56% of patients had urine dip documentation.

• 1st action plan: an addition of key box on system when requesting imaging added following the first audit to ensure urine dip is done prior to requesting CT KUB.

• Results of 2nd audit round: the addition of a prompt in the electronic requesting process to document the presence or absence of microscopic haematuria improved the documentation of this from 56% to 93%, thereby improving the clinical information available at the time of vetting. This has shown improved diagnostics and increased the numbers of patients diagnosed with kidney stones from 40% to 60%.

Urine dip increases diagnostic accuracy by narrowing differentials and therefore if positive clinically then CT KUB is appropriate, otherwise different scans would be more appropriate for different pathologies. This also helps to decrease number of unnecessary radiation. This is seen positively at the local hospital and we noticed significant improvement.

References: British Association of urological surgeons standards for management of acute ureteric colic . Journal of clinical urology 2018, Vol, 11(1) 58-6.