Poster, Podium & Video Sessions
Presentation Authors: Conrad Tobert*, P. Joseph Guidos, Bradley Erickson, Kenneth Nepple, Iowa City, IA
Introduction: The number of Veterans in the US enrolled in the Veterans Health Administration increased by 52% from 2001 to 2014, leading to well-publicized access issues within the health care system. Wait times for routine cystoscopy were high at our VA. We sought a safe way to decrease this time by addressing cystoscopy appropriateness based on guideline compliance.
Methods: A chart review was performed on all men and women scheduled for cystoscopy that were over 3 months past their ideal cystoscopy date. Indications for the procedure, wait time and appropriateness of the scheduled appointment were scrutinized. For bladder cancer patients, the 2016 AUA guidelines on surveillance of non-muscle invasive bladder cancer were used. For all other cystoscopy indications, respective best-practice policy statements were utilized when possible.
Results: There were 152 patients in our system awaiting cystoscopy. Indication for cystoscopy was hematuria work-up in 62 (40.8%), bladder cancer surveillance in 64 (42.1%), neurogenic bladder surveillance in 9 (5.9%), and "other" evaluations (e.g. bladder neck contractures, BPH, AUS erosion, and previous atypical cytology) in 17 (11.2%). Median time between ideal cystoscopy date and scheduled cystoscopy date for new and return patients was 42 (IQR: 31, 61) and 39 (IQR: 31, 49) days, respectively. After review, cystoscopy was deemed inappropriate in 17 (11.1%) patients, the majority of which (n=12; 70.5%) were for overly aggressive bladder cancer surveillance especially for low risk disease (Table 1). Other reasons included neurogenic bladder surveillance in 1 (5.9%) and "other" reasons in 4 (24.6%).
Conclusions: By systematically reviewing our scheduled cystoscopy appointments, over 10% of our cystoscopies in a 3-month period were safely postponed or cancelled simply by compliance with the most up-to-date published guidelines. Review, and subsequent modification, of our practice patterns has simultaneously led to decreased wait times and improved evidence-based medicine.
Source Of Funding: None
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