Presentation Authors: Fady Ghali*, Dimitri Papagiannopoulos, Roger Sur, Seth Bechis, San Diego, CA
Introduction: Retained ureteral stents are a common complication with an incidence near 10%. Retained stents can be associated with significant complications and result in both cost and patient morbidity, and often necessitate more involved surgery to remove, largely due to encrustation. As many as 76% of stents are known to encrust after 12 weeks. Many approaches have been proposed to address this issue, including patient wristbands, phone apps, and external registries which have been met with varying limitations and success. These strategies involve increased documentation burden on the surgeon as well as separate electronic systems such as smartphone applications or registries, raising patient privacy concerns. We sought to design and implement an integrated stent tracking system in order to reduce the rate of retained ureteral stents while minimizing added work on the surgeon.
Methods: We designed and recently implemented a point-of-care (POC), integrated, stent-tracking program within our hospital EMR (EPIC Hyperspace). At time of surgery, our system generates an alert within EPIC to input the â€˜expected explant dateâ€™ of all ureteral stents (implants) placed during the surgery. This information is documented by the circulating nurse at the time that other implant information is entered. The expected explant date is determined by the surgeon and corresponds to the anticipated date of removal. The EPIC system then generates an alert when this expected date has passed, and messages can be sent to the appropriate clinical teams to contact the patient and schedule appropriate followup. We performed a retrospective review of the first 30 patients who underwent stent tracking.
Results: In a pilot study, 30 patients underwent stent placement using the new tracking system, and 26 have had stents successfully removed before the anticipated date of removal. Three patients had stents removed after the expected date, and 1 patient was flagged for missed stent removal and has been subsequently scheduled for a stent removal appointment. We are currently enrolling patients in a database to follow stent removal and assess the efficacy of our tracking system particularly with regard to timeliness of stent removal and incidence of retained or missed stents.
Conclusions: Our integrated stent tracking system embedded within EPIC is a feasible mechanism for potentially reducing the incidence of retained stents while adding minimal administrative and financial burden on the surgeon and hospital. Current studies are ongoing to assess the efficacy of our system at preventing retained stents.