Introduction: Retention of indwelling ureteral stents due to loss to follow-up can result in significant harm to patients, who often require multiple trips to the operating room for endoscopic or percutaneous procedures to remove an encrusted ureteral stent. Unfortunately, an estimated 10% of patients with ureteral stents do not have timely follow-up. Despite widespread use of electronic medical records, there are few standardized options for urologists to track ureteral stents. This pilot quality improvement project aims to use functionality within the Epic electronic medical record to identify all patients with retained ureteral stents that were placed at a single pediatric hospital over a 5-year period and prevent ureteral stent retention moving forward.
Methods: We identified that operating room staff scan a barcode for ureteral stents at the time of surgery to log the stent as "Implanted" in the patient's medical record. The stent can later be marked as "Explanted" at the time of removal. A report was designed within Epic to identify all patients with a ureteral stent implanted from April 2014 to June 2019 at our hospital. We reviewed the records of patients whose stents had never been marked as "Explanted" to determine if any had a retained stent. A workflow was then designed to ensure office staff would mark stents as "Explanted" at the time of removal and to periodically run the report within Epic to ensure that all patients with ureteral stents in place have appropriate follow-up.
Results: Our report identified 152 ureteral stents with a status of "Implanted" from April 2014 to June 2019. There was documentation of removal of 144 of these stents within the patients' medical records, and the status for each stent was updated to "Explanted" at the time of chart reivew. 2 patients whose stents were placed for palliation died with their stents in place. 3 patients did not have evidence of stent removal documented in their medical record. These patients or their parents were contacted, and each reported that the stent was removed at an outside institution or at home by pulling on an externalized string. The remaining 3 patients had their ureteral stents placed within the preceding three months, and each of them had appropriate follow-up scheduled.
Conclusions: All patients with ureteral stents placed at a single institution over a 5-year period were easily identified using an automated Epic report. We anticipate that by reviewing the report on a monthly basis, we will prevent morbidity associated with stent retention. This technique could easily be implemented at other hospital systems that use Epic. Source of