Category: Clinical Stones: Outcomes
Introduction & Objective : Ureteral stents are utilized in the management of many urologic conditions including nephrolithiasis, ureteral strictures, ureteral injuries and malignant obstruction. Prolonged placement has a risk of stent failure with obstruction, infection and encrustation. We describe the novel use of the EPIC electronic medical record (EMR) platform to identify patients lost to follow-up after ureteral stent placement. We additionally identified risk factors for lost stents.
A methodology was created in EPIC to log ureteral stent insertion and removal, with automated reporting of stents implanted for more than 90 days. Starting in January 2015, a nurse reviewed the reports monthly and contacted lost patients to arrange follow-up. We retrospectively reviewed patient charts for clinical characteristics including age, sex, race, surgical urgency (elective vs. emergent), and insurance status to identify risk of failure to follow-up.
Results : We identified 1,788 patients who underwent ureteral stent placement over the study period. Sixteen patients (0.9%) failed to follow-up for ureteral stent explantation (table 1). Using multivariate logistic regression (table 2), stents placed in an emergent setting (OR 3.5, p=0.018) and black race (OR 4.03, p=0.018) were independent predictors of failure to follow-up. Age, sex, and insurance status were not predictors of follow-up. On average explanted stents were in place for 33.6 days versus 327 days among those patients lost to follow up.
Conclusions : Lost ureteral stents are rare, however, potentially high impact events. Automated data collected through an EMR like EPIC facilitates easy identification of these events prior to potential complications. Stents placed in an emergent setting are at a higher risk of poor follow-up as they may not be readily connected in the healthcare system or misunderstand discharge instructions, creating barriers to follow-up. Black race is an independent predictor of a stent being retained and is of uncertain etiology, which will require further investigation to clarify.
Piruz Motamedinia– New Haven, Connecticut
Juan Javier-DesLoges– Resident Physician, Yale New Haven Hospital, New Haven, Connecticut
Katelyn K Johnson– New Haven, Connecticut
Campbell Bryson– Urology Resident, Yale- New Haven Hospital, New Haven, Connecticut
Rachel Olszyk– New Haven, Connecticut
Patrick Kenney– New Haven, Connecticut
Yale New Haven Hospital
New Haven, Connecticut