TMH Kidney Stone Center Shown to Help Keep High-Risk Patients Out of the ED

June 1, 2016

Gyan Pareek, MDResearchers at The Miriam Hospital’s Minimally Invasive Urology Institute (MIUI) have shown that high-risk kidney stone patients were significantly less likely to visit the emergency department for stone-related concerns after establishing care in the institute’s Kidney Stone Center. They presented their findings at the American Urologic Association conference in May.

“The reduction in ED visits among those at greatest risk for recurrent stone disease is linked to our multidisciplinary approach, which allows extended time for urologists, nephrologists and a registered dietician to discuss treatment and prevention with the patient,” said Christopher Tucci, MS, RN, BC, CURN, manager of the institute and study co-author.

The Kidney Stone Center, which opened in 2013, is unique in Rhode Island. Patients have the opportunity to meet with three specialists during a single appointment. “They can get the diagnostic imaging they need and walk out with a comprehensive treatment plan,” Tucci said.

From 2013 to 2015, the study evaluated 238 men and women with a strong history of stone disease, bilateral stones or past stone surgeries. Stone-related complaints decreased from an average of 1.2 visits per patient before enrollment in the center to 0.2 visits following enrollment.

The other authors of the study are urologists George Turini, III, MD, and Gyan Pareek, MD; and registered dietitian Mary Flynn, PhD, RD, LDN.

Q&A with Gyan Pareek, MD  

Gyan Pareek, MD, is a director of the MIUI and director of the Kidney Stone Center at The Miriam Hospital, as well as an associate professor of urologic surgery at The Warren Alpert Medical School of Brown University.  

How does The Miriam’s Kidney Stone Center differ from other services in the region?  

The Miriam’s Kidney Stone Center, which offers three providers in one location, is unique in Rhode Island and southeastern Massachusetts. We are the only center in our region that can provide this level of quality care and patient satisfaction. On the technological side, we use onsite ultrasound to measure new stones and offer patients direct evidence of whether stones are growing or not. Always determined to stay ahead of the curve, we also offer a range of minimally invasive procedures to dissolve or remove stones including ureteroscopy, shockwave and laser lithotripsy, and percutaneous nephrolithotomy.

Why do so many patients go to the ED for kidney stone care?  

Given the current state of our health care system, the ED has become a conduit for patients to get quick care and pain medications. Unfortunately, the ED’s rapid pace is not conducive to helping patients understand their condition and symptoms. Patients often wait several hours. Our dedicated multidisciplinary center provides higher quality care and more time with the patient at each visit.

What factors increase the risk of developing kidney stone disease?  

The most common population to develop kidney stones is working people in their 40s and 50s who are not hydrating well enough. Pediatric patients who develop stones have a higher chance of getting recurrent stone disease. People who are obese and have metabolic syndrome are at a higher risk of developing stones because their urine has stone-promoting factors. Patients who have had intestinal surgeries such as gastric bypass are also at a higher risk, since surgery can impair their ability to absorb things normally. Once you’ve had a stone, you have a 50-percent risk of having another stone within five to seven years.

What is the patient’s role in ensuring their own best health outcome?  

The most important thing a patient can do is come to all the appointments and adhere to all recommendations from the three providers: urologist, nephrologist and registered dietician. Beyond surgical and medical therapies, patients often need to stick to a special diet and increase their hydration levels. Patients often feel more hopeful, informed and capable of preventing new stones after visiting the Kidney Stone Center.

Elena Falcone-Relvas

Senior Public Relations Officer
Bradley Hospital & Hasbro Children's Hospital