Introduction: A recent publication from our institution demonstrated that among the 12.6% of patients that return to the emergency department (ED) within 30 days of ureteroscopy (URS) for stone disease, approximately 60% have a history of psychiatric disease (PD). Small-scale quality improvement studies have suggested that postoperative nursing telephone calls reduce unplanned care encounters after URS for all patients. We sought to determine if a postoperative phone call by a urology nurse targeted to this high-risk group would reduce the rate of post-URS ED returns.
Methods: PD was defined as having a DSM-5 psychiatric diagnosis, a prescription for a psychoactive medication, or documentation by a clinician regarding the diagnosis and management of either. Our cohort was identified by prospectively screening the medical record of all patients undergoing URS for stone disease between August 2018 and August 2019. Patients with a history of chronic pain syndromes or substance abuse were excluded. Patients who met inclusion criteria were called by urology triage nurses between postoperative days 1-4. Nurses reviewed a standardized script with the patient and then used a templated form to document information regarding symptomatology and medication usage. Information regarding ED presentation was obtained by chart review, and outcomes were compared with our previously published retrospective population.
Results: At 12-months follow-up, 42% of 360 patients undergoing URS were identified as having PD. The overall 30-day ED return rate following URS for stone disease was 10.8%, and 56% of the patients who returned had PD. PD patients had an ED return rate of 14.4% (previously 16.7%), and 56% of these visits resulted in admission (previously 36%). The proportion of PD patients returning to the ED with a chief complaint of pain was 32%, whereas previously it was 46%.
Conclusions: PD is a risk factor for post-op ED presentation and is prevalent in patients undergoing URS. Our findings demonstrate that phone calls targeted to these patients may lead to a reduction in 30-day ED returns for reasons that do not require admission, such as pain. Compared with our published retrospective data, the findings of this study reflected an overall reduction in ED returns for PD patients following initiation of postoperative phone calls. Source of