ED visits linked with first-time procedure
ED visits were associated with having a first-time stone procedure and ureteral access sheath usage, while patients who were readmitted more often had lower body mass index, a bilateral procedure, and ureteral access usage compared to the rest of the study population.
“In our study, there were no phone calls, ED visits, or readmissions among the patients who had a stentless procedure, but they are a highly selected group representing only about 10% of patients who undergo ureteroscopy at our institution. From this study, we cannot determine selection criteria that would allow that option to be expanded to a larger group,” Dr. Du said.
Stone number, operative time, Charlson comorbidity index, and history of preoperative urinary tract infection were not significantly associated with any of the types of postoperative encounters.
The department was developing a formal patient education program on ureteroscopy that includes informational brochures and was hoping to implement more extensive counseling provided by dedicated nursing staff to set appropriate patient expectations.
“We believe that many patients think that because there is no incision, they will have minimal discomfort and be able to return to work the day after ureteroscopy. That is not the case, and patients with a stent in particular can have pain that worries them and leads them to call or go to the ED,” Dr. Du said.
“We would also like to track usage of pain medications and then determine if we need to adjust our prescribing. There is a balance to consider because we don’t want to overprescribe narcotic analgesics, but we also do not want to leave patients suffering with uncontrolled pain,” he told Urology Times. Adjunct pain management should also play a larger role in order to reduce narcotic consumption.
In addition, researchers hoped to have dedicated nursing staff make routine follow-up calls to patients a few days after their procedure to identify any concerns and provide reassurance as necessary.
“This strategy involves additional staff time, but in the long run we expect it will be cost-saving because of its potential to reduce ED visits as well as improve patient satisfaction,” Dr. Du said. The clinical care pathway is currently being piloted, and data from the pathway will be reported in the near future.
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