• Peter L Steinberg, Ajay K Nangia, and Kevin Curtis.
• Section of Urology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.
• Qual Manag Health Care. 2011 Jan 1; 20 (1): 30-6.

BackgroundKidney stones are a common, and extremely painful, cause of emergency department (ED) visits. Pain management is a critical component of high-quality patient care. A pilot study at our institution found that only 69% of ED patients with renal colic had evidence of clinically significant analgesia.ObjectiveIn response to these findings, we evaluated the impact of a formalized pain management protocol on timeliness of analgesia among ED patients with renal colic.Subjects And MethodsUsing a before and after study design, adult ED patients with renal colic were eligible. In the prospective arm, patients were treated with ketorolac, 30 mg intravenous, and morphine, 0.05-0.1 mg/kg intravenous, according to a standardized protocol. Results were compared with a retrospective chart review of eligible patients treated during a similar preprotocol period.ResultsImplementation of the protocol resulted in a significant reduction in time to effective analgesia (72 ± 63 vs 37 ± 42 minutes, P = .003). The protocol did not result in any increase in adverse effects.ConclusionImplementation of a standardized pain management protocol among ED patients with renal colic resulted in a marked improvement in quality of care as evidenced by a 49% reduction in time to effective analgesia.

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