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    Unplanned encounters common after ureteroscopy

    Care pathway utilizing education, pain management may help

    Boston—Findings of a retrospective study confirm that unplanned encounters are common after ureteroscopy.

    By identifying underlying factors, the research also suggests strategies for reducing the frequency of these post-procedural events. The study was presented at the 2017 AUA annual meeting in Boston.

    Conducted by urologists at Washington University School of Medicine, St. Louis, the study reviewed data from 157 patients who underwent ureteroscopy for upper tract urolithiasis between January and June 2016. In order to identify patients who may have gone to another hospital for additional care, patients were surveyed about visits to an emergency department (ED) or hospital admission, and 40% of patients provided a response.

    In the 30 days after the procedure, there were 44 unplanned patient-initiated phone calls (28%), 23 emergency department (ED) visits (14.6%) of which almost two-thirds involved imaging, and eight readmissions (5.1%).

    Both the phone calls and ED visits were most often related to pain and involved patients having a first-time stone procedure.

    “Our findings are consistent with previous literature that reports a relatively high rate of post-procedural encounters in patients who undergo ureteroscopy as an outpatient procedure,” said first author Kefu Du, MD, fellow in minimally invasive surgery and endourology at Washington University School of Medicine.

    “We believe that having a clinical care pathway that provides standardized, targeted patient education, pain management, and reassurance may minimize unplanned encounters, improve quality of care, and reduce cost,” added Dr. Du, who worked on the study with Ramakrishna Venkatesh, MD, and colleagues.

    The most common reasons for unplanned phone calls were pain (54.6%), particularly stent-related pain or other symptoms (45.5%), and medication-related issues (13.6%). The leading chief complaints among patients who presented at the ED were flank pain (39%) and hematuria (13%). Three (37.5%) of the eight patients who were readmitted also complained of flank pain. Other presenting issues for the readmitted patients included hematuria (12.5%) and fever (12.5%).

    Unplanned phone calls were received at a median of 5 days after ureteroscopy, ED visits occurred at a median of 8 days, and readmissions occurred at a median of 3 days.

    Factors analyzed as potential predictors for the post-procedural events included demographic features, urolithiasis history, stone characteristics, and operative details. Factors associated with a higher rate of phone calls were having a first-time stone procedure, intraoperative stent placement, and stent removal at home.

    Next: ED visits linked with first-time procedure


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