Quality standard

Quality statement 1: Diagnostic imaging

Quality statement 1: Diagnostic imaging

Quality statement

Adults with suspected renal colic have low-dose non-contrast CT within 24 hours of presentation.

Rationale

CT should be performed as soon as possible, unless it is contraindicated, to prevent delays to diagnosis and treatment that can cause renal function to decline. CT within 24 hours also prevents people being in pain for long periods while they wait for a scan and definitive management.

Quality measures

Structure

a) Evidence of the availability of CT scanning equipment to perform low-dose non-contrast CT scans for adults with suspected renal colic.

Data source: Local data collection, for example, service specifications.

b) Evidence of the availability of staff to perform low-dose non-contrast CT scans for adults within 24 hours of presentation with suspected renal colic.

Data source: Local data collection, for example, staff rotas.

Process

a) Proportion of low-dose non-contrast CT scans performed within 24 hours of presentation for adults who presented in primary care with suspected renal colic.

Numerator – the number in the denominator performed within 24 hours of presentation.

Denominator – the number of low-dose non-contrast CT scans for adults who presented in primary care with suspected renal colic.

Data source: Local data collection, for example, local audit of patient records from radiology departments.

b) Proportion of low-dose non-contrast CT scans performed within 24 hours of presentation for adults who presented in an emergency department with suspected renal colic.

Numerator – the number in the denominator performed within 24 hours of presentation.

Denominator – the number of low-dose non-contrast CT scans for adults who presented in an emergency department with suspected renal colic.

Data source: Local data collection, for example, local audit of patient records from radiology departments.

c) Average time from people presenting with suspected renal colic to having a low-dose non-contrast CT scan.

Data source: Local data collection, for example, local audit of patient records from radiology departments.

Outcome

Level of renal function for people with renal and ureteric stones.

Data source: Local data collection, for example, local audit of patient records.

What the quality statement means for different audiences

Service providers (such as GP practices and emergency departments) ensure that staff are aware of referral pathways and that services work together to refer adults with suspected renal colic for low-dose non-contrast CT. They ensure that CT scanning equipment and staff are available to perform low-dose non-contrast CT for adults with suspected renal colic within 24 hours of presentation.

Healthcare professionals (such as primary care practitioners, emergency department practitioners and paramedics) take a medical history and carry out a clinical examination of adults presenting with acute abdominal or flank pain. They are aware of referral pathways for low-dose non-contrast CT, and they refer adults with suspected renal colic to have this imaging within 24 hours of presentation, unless it is contraindicated (for example, in pregnant women).

Commissioners (such as clinical commissioning groups and NHS England) ensure that services have referral pathways and work together to refer adults with suspected renal colic to have low-dose non-contrast CT within 24 hours of presentation, unless it is contraindicated (for example, in pregnant women). Services should have the equipment and capacity to perform this imaging within 24 hours of presentation.

Adults with severe pain that could be kidney stones have an examination of their abdomen and discuss their symptoms with a healthcare professional. If the doctor thinks they might have a kidney stone, they have a CT scan within 24 hours, unless there is a reason why it is unsuitable (for example, they are pregnant).

Definitions of terms used in this quality statement

Suspected renal colic

Suspicion based on history and clinical examination of people presenting with abdominal or flank pain in general. [NICE's guideline on renal and ureteric stones, evidence review B]

Equality and diversity considerations

If renal colic is suspected in pregnancy, ultrasound should be offered instead of CT to avoid the risks associated with radiation exposure in pregnancy.

Children and young people should not receive non-contrast CT as first-line imaging for suspected renal colic. Ultrasound should be offered instead to minimise radiation exposure.