Medical expulsive therapy in a tertiary care emergency department

Objective: To assess the extent of Medical expulsive therapy (MET) use and practice patterns in our tertiary care emergency department. MET is the first-line intervention for select symptomatic urolithiasis recommended by the American Urological Association and supported by clinical trials investigating its efficacy. Nonetheless, MET is not always prescribed in the emergency department setting for symptomatic patients with ureteral stones. Methods: Using the "International Classification of Diseases" diagnostic codes, we retrospectively reviewed the medical records of all emergency department patients treated for urolithiasis at our institution from January to December 2008. Abstracted patient data included demographic and medically relevant information; MET use was determined by reviewing the electronic prescriptions at discharge. Results: Of 165 patients identified with a diagnosis of renal colic owing to urolithiasis, 23 were excluded for suspected stone passage or failure to document a stone on cross-sectional imaging. Most (138 [97%] of 142) of the remaining patients met the criteria for outpatient treatment of symptomatic stone episodes and were eligible for MET. Urology consultation was requested in 19 outpatients (13%), and MET was prescribed for most (14 [73.7%] of 19). Of the 119 patients seen by an emergency department physician without urologic input and discharged, 17 (14%) received MET. Overall, tamsulosin was prescribed to 31 (22%) of 138 stone episodes treated with an outpatient trial of passage. Conclusion: The underusage of tamsulosin in the emergency department of our institution highlights the need for educational interventions to improve the quality and cost of emergent patient care.