Variable Use of Postoperative Imaging Following Ureteroscopy: Results from a Statewide Quality Improvement Collaborative

Dauw, Casey A.; Ghani, Khurshid R.; Qi, Ji; Kim, Tae Il; Telang, Jaya; Seifman, Brian; Jafri, Mohammed; Blix, Gregor; Hollingsworth, John M.

doi:10.1016/j.urology.2019.07.055

Cited by 16 publications

(8 citation statements)

References 16 publications

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“…Less, etc., results in greater therapeutic efficacy and safety and is the initial treatment approach [ 2 , 3 ]. Nonetheless, intraoperative disinfection, infusion temperature, anaesthesia method, skin exposure, and other factors can influence the treatment process, resulting in lower body temperatures in patients, which increases the risk of surgery, and postoperative patients will experience varying degrees of pain and complications, as well as depression and anxiety [ 4 ]. As a result, multidimensional nursing should be provided.…”

Section: Introductionmentioning

confidence: 99%

Impact of Cluster Nursing on Nursing on VAS Score and Urinary Function of Patients after Percutaneous Nephrolithotomy with Pneumatic Lithotripsy (PCNL)

Chen

Zhao

et al. 2022

Applied Bionics and Biomechanics

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Objective. To explore the effects of cluster nursing on VAS score and urinary system function of patients after percutaneous nephrolithotomy with pneumatic lithotripsy (PCNL). Methods. November 2019-January 2019, 114 patients with PCNL who received treatment in our hospital were selected and randomly divided into two groups: the control group and the study group. The study group received cluster nursing, and the control group received routine nursing. Compare the Barthel index (BI), between two groups, SAS score, complications rate, surgical outcomes, pain scores, quality of life scores, knowledge awareness rate, and satisfaction rate were compared. Results. There were no significant variations in Bi and SAS scores before the nursing ( P > 0.05 ). The BI ratings were clearly higher after nursing, whereas the SAS and pain levels were considerably lower, however, the research group altered more dramatically ( P 0.05 ). The study group’s incidence of complications was lower ( P 0.05 ) than the control group’s; the study group’s hospitalization cost was lower, and the hospitalization and lower bed activity were shorter ( P 0.05 ); after the nursing, the organised quality score was significantly higher in both groups, but the research group changed more dramatically ( P 0.05 ). Compared with the control group, the knowledge of the research team was higher ( P < 0.05 ); after the nursing, both group satisfaction scores were obviously high, but the study group changes more significantly ( P < 0.05 ). Conclusion. After PCNL treatment, the patient receives cluster therapy, improving the patient’s anxiety, reducing the degree of pain, and improving the quality of life in patients, and the patient satisfaction is high. Therefore, cluster nursing is worthy of extensive application in the postoperative care of patients with PCNL.

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Section: Introductionmentioning

confidence: 99%

Impact of Cluster Nursing on Nursing on VAS Score and Urinary Function of Patients after Percutaneous Nephrolithotomy with Pneumatic Lithotripsy (PCNL)

Chen

Zhao

et al. 2022

Applied Bionics and Biomechanics

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“…MUSIC ROCKS maintains an all-payer, prospective clinical registry containing demographic and clinical data for patients undergoing URS or shock wave lithotripsy and their 60-day postoperative outcomes. 7,8 Data abstraction is conducted at each practice by trained personnel. Data fidelity is ensured by data audits and site visits.…”

Section: Methods Data Sources and Study Populationmentioning

confidence: 99%

Improving the Quality of Upper Urinary Tract Stone Surgery: External Validation of a Statewide Collaborative’s Efforts to Reduce Emergency Department Visits After Ureteroscopy

et al. 2023

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Purpose:The ROCKS (Reducing Operative Complications from Kidney Stones) program in MUSIC (Michigan Urological Surgery Improvement Collaborative) was created to optimize ureteroscopy outcomes. Through data collection, distribution of reports, patient education, and standardization of medication, post-ureteroscopy emergency department visits in Michigan have declined. It is unclear whether this is because of statewide quality efforts or due to national trends. We therefore sought to understand emergency department visit rates in Michigan compared to a national data set.Materials and Methods:We compared the MUSIC ROCKS clinical registry in Michigan against a national cohort, Optum’s de-identified Clinformatics Data Mart, from 2016-2021 (excluding Michigan). We identified patients who underwent ureteroscopy and the proportion who had a postoperative emergency department visit within 30 days. Emergency department rates were modeled over time, adjusting for age, gender, comorbidity, and ureteral stenting.Results:We identified 24,688 patients in MUSIC ROCKS and 99,340 in the Clinformatics Data Mart database who underwent ureteroscopy. The risk-adjusted emergency department visit rate in MUSIC ROCKS significantly declined over the study period (10.5% in 2016 to 6.9% in 2021, P < 0.001) while the mean emergency department visit rate in the Clinformatics Data Mart cohort was 9.9% and did not change over time (9.6% in 2016 to 10% in 2021). Comparing emergency department visits between the cohorts, the MUSIC ROCKS rate significantly declined relative to the Clinformatics Data Mart (P < 0.001) over the study period.Conclusions:Postoperative emergency department visit rates in Michigan have declined significantly after ureteroscopy since the establishment of MUSIC ROCKS. This decline outpaced national rates, providing evidence that systematic quality initiatives can improve urological care.

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“…The data set records numerous variables, but it does not have the granularity to look at every specific detail such as stent presence at the time of ED visit or hospitalization, although this may represent an area of future research. In addition, our overall rate of postoperative imaging is low, 17 so conclusions about the SFR must be drawn cautiously. That said, our rate of postoperative imaging is consistent with national claims-based data suggesting that imaging is performed in less than 50% of patients undergoing URS.…”

Section: Uas In Statewide Collaborativementioning

confidence: 99%

Understanding Ureteral Access Sheath Use Within a Statewide Collaborative and Its Effect on Surgical and Clinical Outcomes

Meier

Hiller

Dauw

et al. 2021

Journal of Endourology

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Introduction: Ureteral access sheaths (UASs) are frequently used during ureteroscopy (URS), but their use is not without potential risk. We investigated patterns of UAS use and associated outcomes across practices in Michigan within a quality improvement collaborative. Methods: The Michigan Urological Surgery Improvement Collaborative (MUSIC) Reducing Operative Complications from Kidney Stones (ROCKS) initiative maintains a web-based, prospective clinical registry of patients undergoing URS for urinary stone disease (USD). We analyzed all patients undergoing primary URS for renal and ureteral stones from June 2016 to July 2018 in the ROCKS registry. We determined rates of UAS usage across practices and associated outcomes, including 30-day emergency department (ED) visits and hospitalization, as well as stone-free rates. Using multivariate logistical regression, we determined the predictors of UAS use as well as outcomes, including stone-free rates, ED visits, and hospitalizations, associated with UAS use. Results: Of the 5316 URS procedures identified, UASs were used in 1969 (37.7%) cases. Stones were significantly larger and more likely to be located in the kidney in cases with UAS use. UAS use during URS varied greatly across practices (1.9%-96%, p < 0.05). After adjusting for clinical and surgical risk factors, UAS use significantly increased the odds of postoperative ED visits (odds ratio [OR] = 1.50, 95% confidence interval [CI] 1.17-1.93, p < 0.05) and hospitalization (OR = 1.77, 95% CI 1.22-2.56, p < 0.05) as well as decreased the odds of being stone free (OR = 0.75, 95% CI 0.57-0.99, p < 0.05). Conclusions: In the current study, UAS use during URS for USD was not associated with an increased likelihood of being stone free; moreover, it increased the odds of a postoperative ED visit and or hospitalization. Our findings demonstrate that UAS use is not without risk and should be employed judiciously.

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Variable Use of Postoperative Imaging Following Ureteroscopy: Results from a Statewide Quality Improvement Collaborative

Cited by 16 publications

References 16 publications

Impact of Cluster Nursing on Nursing on VAS Score and Urinary Function of Patients after Percutaneous Nephrolithotomy with Pneumatic Lithotripsy (PCNL)

Impact of Cluster Nursing on Nursing on VAS Score and Urinary Function of Patients after Percutaneous Nephrolithotomy with Pneumatic Lithotripsy (PCNL)

Improving the Quality of Upper Urinary Tract Stone Surgery: External Validation of a Statewide Collaborative’s Efforts to Reduce Emergency Department Visits After Ureteroscopy

Understanding Ureteral Access Sheath Use Within a Statewide Collaborative and Its Effect on Surgical and Clinical Outcomes

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