Does a Ureteral Stent Tracking Database Reduce the rate of Retained Ureteral Stents?
Tatum Williamson, MD, Peter Steinberg, MD, Erin Casey, RN.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
Introduction Retained ureteral stents can result in significant patient morbidity, leading to urinary tract infections, hematuria, voiding symptoms, and due to encrustation, require additional procedures for removal. In addition, retained stents are a source of medicolegal liability for urologists. To reduce the rate of retained stents at our institution, we devised and implemented a operating room billing software based ureteral stent tracking system. In this study, we compared the incidence of retained stents and the average stent dwell time before and after implementation of our stent tracking system. Materials and Methods The stent tracker system went live on June 24th, 2020. Patients were enrolled automatically into the system whenever the circulating nurse billed for a ureteral stent associated with the patient's surgery. Stents were queried in a database by either surgeon or date of placement and reconciled as removed by the provider who removed the stent and/or the quality assurance team in our urology practice. We retrospectively enrolled all patients who underwent ureteral stent insertion by urologists or transplant surgeons at our institution from May 19th, 2019 to June 23rd, 2020, and prospectively enrolled all patients who underwent stent placement from June 24th, 2020 to December 30th, 2022. We excluded patients with chronic indwelling stents on routine exchanges (i.e. for malignant obstruction) as well as patients who expired with an indwelling stent. Patients whose stent was removed but at an unknown date were also excluded from analysis. Retained stents were defined as stents in place for more than 90 days. We calculated both the rate of retained devices and the average dwell time. We compared the retrospective to the prospective cohort using descriptive statistics and comparisons between groups were done with the Student's T test. Results From May 19th, 2019 to December 31st, 2022, a total of 1818 stents (588 pre-database and 1230 post-database) were placed in 1160 patients. A total of 6 patients (0.5%) could not be located to determine the status of their stent – 1 retrospective and 5 prospective. The retrospective cohort had a significantly longer average dwell time (pre: 33±40 vs. post: 29±34, p<0.05). There was a significant decrease in the rate of retained stents (pre:15.7% [61/388] 5.4% [46/858], p<0.01) after implementation of the database.
Conclusions Tracking of ureteral stents is essential to prevent patient morbidity. Implementation of an electronic medical record-based stent tracking system decreased stent dwell time and frequency of retained stents, thus protecting patients from unnecessary complications, and protecting urologists from potential liability.
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