Optimising our GIRFT acute regional lithotripsy service—Improving efficiency and access for those most likely to benefit
Bibliographic record
Abstract
Introduction: NICE recommends the use of extracorporeal shockwave lithotripsy (ESWL) for the primary, definitive management of ureteric stones that are unlikely to pass or are causing intolerable pain. Our department hosts an acute regional ESWL service for treatment of ureteric stones, as championed by GIRFT. A quality improvement project was undertaken to improve access and efficiency of our service. Methods: A prospective database of patients attending for ureteric ESWL January−March 2022 was used. Patients attending for their first treatment were included, and their complete stone episode was assessed. Data were gathered on stone characteristics, treatment timescales, and outcomes. Statistical analysis was performed using Fisher's exact and unpaired t-test. Results: One hundred and twenty patients were reviewed, of which 68 met inclusion criteria. Sixty-three percent of patients were treated, of which 91% experienced a successful stone clearance after a median of one treatment. 37% of patients were unable to be treated due to the stone not being localised; these patients had significantly smaller stones (5.2 mm versus 7.2 mm; p = 0.0017), lower density (607.9 HU [Hounsfield units] versus 767.8 HU; p = 0.0096) and a higher chance of spontaneous passage (Mimic Spontaneous Stone Passage score 60.9% versus 42.2%, p = 0.0017). Stone sizes <5 mm, density >500 HU, or Mimic Spontaneous Stone Passage score >60% are less likely to be localised. Patients referred from peripheral units waited significantly longer for their first treatment (17.1 days versus 7.4 days; p = 0.0118); however, they did not have a lower chance of treatment success (86% versus 91%; p = 0.6113). Discussion: We present a very effective service for those able to be treated. Parameters could be used, alongside individual clinical assessment, to consider patients primarily for a trial of conservative management. This would aim to reduce unnecessary attendances and thus, improve access and wait times for those most likely to benefit. Our results indicate that shorter wait times may not improve treatment success, but we anticipate benefit to patient experience. Further evaluation of longer wait for treatment should be conducted using patient-reported outcome measures.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".