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Forgotten stents are one of the most common challenges urologists and their patients face, and they can cause significant complications and increase costs of care. Now, a program that tracks stent insertion and removal in the electronic medical record shows strong potential to help eliminate retained stents.
Chicago-Forgotten stents are one of the most common challenges urologists and their patients face, and they can cause significant complications and increase costs of care. Now, a program that tracks stent insertion and removal in the electronic medical record shows strong potential to help eliminate retained stents.
Nearly 10% of ureteral stents are retained, and 76% begin to encrust after 12 weeks. Researchers at UC San Diego School of Medicine’s department of urology sought to design an EMR-integrated stent tracking system “that doesn’t increase documentation for physicians” and helps to prevent incidence of retained stents, Fady Ghali, MD, a second-year urology resident, told Urology Times.
A case study on the initiative was presented at the AUA annual meeting in Chicago.
The authors worked with Epic to design a point-of-care tracking system that prompts the circulating nurse to input the expected explant date of all ureteral stents placed during surgery, as determined by the surgeon. The information is documented at the same time all other implant information is entered, making this step easy to incorporate into existing clinical workflows.
Epic then generates an alert when this expected explant date has passed, with messages sent to the appropriate clinical team to contact the patient and schedule a follow-up appointment.
System flags patient for missed removal
The results were striking. Among 30 patients who underwent ureteral stent placement using the new tracking system:
• 26 underwent successful stent removal before the anticipated date of removal.
• Three patients’ stents were successfully removed after the expected explant date.
• One patient was flagged for missed stent removal and was subsequently scheduled for an appointment to remove the stent.
Today, the authors enroll all ureteral stent patients into a database to assess the efficacy of the EMR tracking system, particularly with regard to timeliness of stent removal and incidence of retained or missed stents.
The approach is a feasible method for reducing the incidence of retained stents while limiting the administrative and financial burden on the surgeon and the hospital, said Dr. Ghali, who worked on the study with Seth K. Bechis, MD, and colleagues.
Next:"Since the rollout, we’ve seen very quick assimilation [among clinicians]”“It’s easily incorporated into clinical practice with some education. Since the rollout, we’ve seen very quick assimilation [among clinicians],” Dr. Ghali said.
The tool was easy to design and implement, Dr. Ghali told Urology Times.
“We sat with our Epic folks and told them what we wanted, and they worked with us to design it,” he said.
Previous attempts to more effectively avoid incidence of retained stents-such as patient wristbands, mobile phone apps, and external registries-have been met with varying limitations and success, according to the authors. Such strategies typically increase the documentation burden for the surgeon. They also require separate electronic systems, such as smartphone applications or registries, to track patients who have received stents, raising concerns around patient privacy.
The success of an EMR-integrated clinical tracking system for stent removal could point to the potential to use EMR-integrated tracking for other procedures and conditions, Dr. Ghali told Urology Times.
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