INTRODUCTION: Manual paper database systems are commonly used to monitor JJ ureteric stent placement and removal. System failure can lead to patient morbidity and medicolegal implications. The objective of this study was to audit a stent database system at a large urology center in Western Sydney to determine the adequacy of the tracking procedure.
METHODS: From our single tertiary academic center, 316 patients underwent ureteric stent insertions in 2007. We conducted a retrospective analysis of the dates of stent insertion and removal (indwelling time). We noted if documentation of stent removal was clear (ie, in a surgical unit stent logbook, our urology office, or a consultant's records). If the stent removal date was unclear, clarification was sought from surgery records, inpatient manager software, patient files, records from other hospitals, or contact with the patient. Patients were divided into 5 stent follow-up categories and statistical analysis (using one way ANOVA and logistic regression) was used to make comparisons between groups. We used a stent indwelling time of 6 months as the maximum acceptable duration in situ.
RESULTS: A total of 379 stent procedures were conducted. The majority of patients had single, unilateral, denovo procedures due to stone disease. The majority of the removed stents had adequate documentation (n = 214; 56.5%). A total of 23 patients (6.1%) were deceased prior to stent removal. The remaining 142 (37.5%) of patients had no record of their stent removal in our database. Overall, 22.4% of all ureteric stents exceeded the 6-month maximum indwell time. These results were largely due to poor record keeping, loss or misplacement of endourological operation reports, or failure to notify the consultant who placed the sent if the patient was referred to other hospitals or consultants.
CONCLUSION: Based on the present and previous studies, the manual paper database system of ureteric stent follow-up is ineffective. We propose an electronic database recall system that alerts the attending urologist of an overdue stent and is readily accessible from within and outside the hospital.
Shagun Aggarwal, Howard M H Lau, Andrew J Brooks, Simon V Bariol, Malcolm Drummond, Manish I Patel, David Ende, Audrey C. Wang, Henry H Woo
Submitted: December 18, 2010
Accepted for Publication: January 13, 2011
KEYWORDS: Audit; Ureteric stents; Paper logbook database
CORRESPONDENCE: A/Prof Henry Woo, P.O. Box 5017, Wahroonga, NSW, 2076, Australia ( ).
CITATION: Urotoday Int J. 2011 Apr;4(2):art23
doi:10.3834/uij.1944-5784.2011.04.05