A snapshot of recent urology QI programs

Quality improvement programs address all aspects of care and care delivery. Here are a few programs that impact urology, all of which were presented at the AUA annual meeting in Boston:

VTE prophylaxis. Terry et al studied the safety and efficacy of postoperative extended duration of venous thromboembolism (VTE) prophylaxis in high-risk urologic oncology patients. Researchers showed that at 28 days post-op, enoxaparin appears to be safe and effective to prevent venous thromboembolism after surgery for urologic malignancies. It was a small series. But the observed rate of symptomatic VTE within 30 days was 0%, with no complications, in a population of patients in which 98% were at high VTE risk. 

Difficult catheterization. Faraj et al implemented a QI program at a large community hospital looking at inappropriate catheter use, catheter trauma, and urologic procedures that might have been avoided. They got their stakeholders-nurses-involved to see how the process worked and could be improved. They developed a skilled catheter nursing team, did nursing education, and developed an algorithm for difficult urinary catheterization. As a result, both catheter trauma and the need for urologic procedures dropped.

Robotic skills. Peabody et al utilized peer review of surgical videos from MUSIC and found that the technical skill of robotic surgeons varied widely among surgeons performing prostatectomy. Better skills were associated with better results. The researchers have used the findings to facilitate peer-to-peer coaching to help other surgeons improve their technical skills.

Drivers of post-RP readmissions. Kachroo et al, also from the MUSIC group, used their NOTES (Notable Outcomes and Trackable Events after Surgery) metric to understand drivers of 30-day readmission after radical prostatectomy. They found that gastrointestinal complications are major drivers of early readmission after prostatectomy. Future QI efforts should focus on patient education and post-op surveillance, they recommend.

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