Nearly 10% of URS patients visit emergency room
An analysis of nearly 2,000 patients undergoing ureteroscopy found that approximately 10% of the cohort had an emergency department visit after the procedure, a figure a statewide quality improvement initiative is looking to reduce via patient education regarding ureteral stents.
San Francisco-An analysis of nearly 2,000 patients undergoing ureteroscopy found that approximately 10% of the cohort had an emergency department visit after the procedure, a figure a statewide quality improvement initiative is looking to reduce via patient education regarding ureteral stents.
The Michigan Urological Surgery Improvement Collaborative (MUSIC) launched Reducing Operative Complications from Kidney Stones (ROCKS), its first quality improvement initiative beyond prostate cancer, in August 2016. At the 2018 annual meeting meeting in San Francisco, Khurshid R. Ghani, MD, MS, reported the group’s analysis of post-ureteroscopy ED visits.
The analysis included almost 2,000 patients treated with ureteroscopy at nine practices across the state. Focusing on unplanned encounters within the first 30 days after the procedure, the analysis found that approximately 10% of patients had an ED visit, of which 57% were considered potentially modifiable events, occurring for reasons of flank pain, hematuria, or urinary symptoms. Seventy percent of patients with an ED visit had a stent.
The ED visit rate among the nine practices included in the analysis ranged from 3% to 13%. Based on the observation that the practice with the lowest modifiable ED visit rate provided the most intensive patient education and because no practice had dedicated information related to stent symptoms, ROCKS addressed this gap by developing a ureteral stent patient education leaflet, which has been distributed to participating practices with the hope that trips to the ED can be minimized by setting proper patient expectations.
“Measuring to acquire data and sharing the information is not enough. We also have to develop action plans and disseminate interventions,” said Dr. Ghani, associate professor of urology, University of Michigan, Ann Arbor, and co-director of MUSIC.
“While we are starting small and focusing on stent-related issues for the moment, we know there are many things that we need to do to reduce ED visits after ureteroscopy.”
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