Healthcare Innovation Evaluation: Renal Colic Audit

This document outlines a healthcare innovation project focused on evaluating the use of plain CT KUB as a first diagnostic option for renal colic patients at Sohar Hospital. The project aims to establish a new imaging protocol to minimize patient waiting times, reduce treatment pathways, and improve the overall management of renal colic. The proposal includes a literature review justifying the need for the research, a feasibility check, a proposed methodology (initially mixed methods, later changed to retrospective quantitative), ethical considerations, and key ethical issues. The study will analyze data using SPSS to compare pre- and post-study waiting times and will seek ethical approvals from both the Ministry of Health in Oman and the University of Hertfordshire.

Outline/Proposal Form
Evaluation of a healthcare innovation in practice (clinical audit with pre- and post-
change evaluation)
Student’s Name and
Profession
Working Title
(Maximum 30 words)
Plain CT KUB as a First Diagnostic Option for Renal Colic Patients
In Sohar Hospital
Audit area
Give the topic and
professional/clinical area for your
research.
Plain CT KUB as a First Diagnostic Option for Acute Renal Colic
Patients in Sohar Hospital
Radiology Department
Audit question
Must be accurate, succinct and
answerable
Can Plain KUB CT scan be used as the first diagnostic option for acute
renal colic patients at Sohar Hospital?
Aims/Objectives
Consider primary and secondary
aims/objectives for your audit.
1) Establish new imaging protocol for acute renal colic patients.
2) Minimise renal colic patient`s radiology waiting list.
3) Reduce renal colic patient’s treatment pathway.
A new Lithotripsy Unit has been recently introduced in Sohar Hospital.
This study aims to establish new imaging protocol in order to help renal
colic patients in terms of diagnosis and treatment pathway as the current
imaging protocol is complicated.
Brief justification for work
Brief review of the key literature,
demonstrating ‘need’ for the
research and possible clinical
relevance or implications
(Maximum 250 words)
Computed tomography of the kidneys, ureter and bladder (CT
KUB) has become the reference technique in medical imaging for
renal colic patients, to diagnose, plan treatment and explore
differential diagnosis. Despite the limitations and the radiation risk
of CT scan; CT KUB is the accepted gold standard investigation for
suspected renal colic and it replaces intravenous urography (IVU)
in many hospitals because it is a diagnostically superior (sensitivity
97-98 %, specificity 96 – 100 %), contrast-free, quicker, safer and
more cost effective investigation for acute renal colic (Bariol et al.,
2005; Chowdhury et al., 2007; Kennish et al., 2008; Yong, 2009;
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Patatas et al., 2012).
Sohar Hospital in Oman is a 400 bed hospital which serves a population
of over half a million people, and it has only one CT machine and two
ultrasound machines which are used for eight hours every day a week.
In fact, with reference to the statistics of Radiology Department at
Sohar Hospital; there were about 1420 CT KUB examinations done
in the period between January 2013 and July 2016, all those
patients definitely have done some radiological examination as
initial investigation such as: US, IVU or plain KUB x-ray (Sohar
Hospital, 2016). This means that patient radiological investigation
was delayed (appointments after 3 months), increased risk of
patient radiation dose, increased risk of contrast reaction and
unnecessary waste of radiological facilities which of course end
with complicated patient management and treatment pathway.
Early and accurate diagnosis of renal colic which is crucial as it plays a
major role in the early management of the condition as well as post
treatment planning (Ripolles et al., 2004; Rucker et al., 2004).
Feasibility Check
Detail where and how you have
checked for existing research in
this area, and show how your
question will add to any existing
research (Include key references
you have found)
Two ways of search were conducted in order to check how this issue is
manged with other institutions.
1) A survey of clinical protocols being used in Oman hospitals will be
carried out to find out how each hospital manages renal colic
patients. This will be a telephone interview with the Head of
Radiology Department of individual hospitals.
2) Initial literature review of radiology journals, which was conducted
via Hertfordshire University study net library through research
engines such as: PubMed, Science Direct, CINHAL Plus.
(see appendix 1 for a list of references)
Proposed methodology
Detail your approach and audit
design. eg proposed change/s and
their measurement and evaluation,
data collection methods, sample,
The initial methodology of this study was a mixed method design
for data collection. Mixed method is used to combine qualitative
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recruitment, etc
Type of analysis: detail how you
will analyse your audit data.
(Maximum 250 words)
and quantitative data in order to maximise the strengths of each,
thus, helps to answer questions that are difficult to be answered by
one approach (Ozawa & Pongpirul, 2013). Mixed method design
helps to view the topic from multiple perspectives in order to
develop a complete understanding, to reduce intrinsic bias which
comes from single method and to triangulate findings. On the other
hand, mixed method creates more data, which means more
analyses, high cost and more efforts (Johnson et al, 2007).
Unfortunately, the methodology will be changed from a mixed
method to a retrospective quantitative study due to the short
timeframe to conduct the audit. In this study; quantitative data will
be numerical data of patients, appointments, machines, etc
The initial data analyses will be done via excel software. The final
data analyses will be carried out using SPSS by student`s t-test in
order to see the deference of renal colic patient`s waiting list pre
and post the study.
The next stage is to establish diagnostic criteria protocol for acute
renal colic which should be followed by all A&E physicians in order
to request non enhanced CT KUB.
Ethical considerations
(Please tick)
University of Hertfordshire (for non NHS studies)
Local NHS R&D approval, check Trust’s procedures.
Manager’s approval needed – ethical approval is not normally
required for “data audit only” studies (often the case for audits)
No ethical approval required (please state reason – maximum 30
words)
NHS studies requiring NRES approvals will not be accepted onto
this module unless approvals have already been obtained before this
outline is submitted and copies of all approvals are attached to this
outline. If you are undertaking a clinical audit you will need prior written
permission from the clinical management (NHS or private)
Please provide a copy of your written permission to undertake this
audit (and to disseminate its findings) from the appropriate
manager.
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Key ethical issues
Briefly state other potential ethical
issues and how may be addressed
eg confidentiality, anonymity,
inconvenience, risk etc
(Maximum 150 words)
As the researcher is an international student, and the study will be
conducted in his own country, therefore, ethical approval will be obtained
according to the system being used in Ministry of Health in Oman.
First of all, the researcher has applied for ethical approval to the
Committee of Ethical Issue and Scientific Research attached with a copy
of proposal. (see appendix 3 for a copy)
Written permission approval will also be obtained from the radiology
department.
All patients detail will be anonymous.
At the end of the study, the participating department will be provided with
a copy of the findings including the MOH.
After ethical approval is obtained from MOH Oman, an ethics approval
will be obtained from University of Hertfordshire, School of Health
and Social Work.
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