ROCKS study takes big initial step in improving care

January 25, 2019

"The concept of 'surgical quality' is emerging as an important component of health care delivery. At present, though, there is no universally accepted definition of what surgical quality is; indeed, this term may mean different things to different physicians, patients, and others," writes Brian R. Matlaga, MD, MPH.

Dr. Matlaga, a member of the Urology Times Editorial Council, is professor of urology at the James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore.

 

The concept of “surgical quality” is emerging as an important component of health care delivery. At present, though, there is no universally accepted definition of what surgical quality is; indeed, this term may mean different things to different physicians, patients, and others.

A variety of efforts have been made to identify specific quality indicators that can be applied to the delivery of surgical care. One of the metrics utilized in a number of studies is the rate of readmission following a surgical intervention. Although there exists uncertainty as to how efforts to reduce hospital readmissions may affect public health, due to their easy-to-track nature, hospital readmission rates will likely remain a quality metric of interest for the foreseeable future. 

As urologists, it is important that we understand factors that can affect hospital readmissions. Due to the prevalence of the condition, an increase in readmission rates associated with kidney stone procedures may account for a large burden on the health care system. Although some readmissions may be medically necessary and not preventable, it may be that certain maneuvers can reduce the likelihood of other readmission scenarios.

This issue of Urology Times features a discussion of the Reducing Operative Complications from Kidney Stones (ROCKS) effort from the University of Michigan group (see article here). This study provides the practicing urologist with a number of instructive lessons.

Also see: Tolterodine pretreatment does not improve stent symptoms

In the ROCKS study, Dr. Ghani and colleagues evaluated patients who underwent ureteroscopy (URS) and assessed factors associated with emergency department visits following the procedure. They found approximately 10% of patients who undergo URS will visit an ED within 30 days of the procedure, and most of these encounters are related to stent symptoms and pain. The great value of the ROCKS study is that it identifies potential areas in which care can be improved.

One need identified in the ROCKS study is an opportunity to better manage stent-related symptoms. However, given the present opioid crisis in the United States, it is important to look for ways to address this problem in a manner that does not rely on simply providing additional narcotic agents for pain control. The ROCKS team assessed that improving the educational materials provided to patients undergoing URS would better prepare them for symptoms associated with ureteral stents. 

A patient who has a better understanding of what post-URS stent symptoms may be expected, and how they may be mitigated, should have a better experience than a patient who is unprepared for such symptoms. It will be exciting to see if this is borne out in future studies.