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IMPLEMENTATION OF A STANDARDIZED APPROACH TO PEDIATRIC POSTOPERATIVE URINARY RETENTION DECREASES RATE OF INTERVENTION
  1. Katie Meier,
  2. Lisa Benz,
  3. Stephanie Greger,
  4. William Zurkuhlen,
  5. Margaret R. Ninemire,
  6. Kayla Churay,
  7. Joshua Gossett,
  8. Erika Stalets
  1. Cincinnati Children's Hospital Medical Center, USA

Abstract

Background To date, the literature contains no information regarding incidence, definitions, or evidence-based management guidelines for pediatric postoperative urinary retention. Prior to our project, up to 20% of pediatric orthopedic patients at our institution required intervention for suspected urinary retention prompting a multidisciplinary team to draft an algorithm incorporating patient-specific data to identify and manage retention.

Objectives

  1. Increase the percentage of pediatric orthopedic patients with postoperative Foley catheters who had patient-specific management plans for urinary retention (defined as EMR order indicating bladder scan timing utilizing recent urine output and expected bladder capacity).

  2. Monitor urinary retention and catheter-associated urinary tract infection (CAUTI) rates.

Methods All orthopedic patients admitted to a single acute care unit in our freestanding children's hospital with postoperative Foley catheters were included; patients with neurogenic bladders were excluded. Multiple plan-do-study-act cycles were employed to increase the percentage of patient-specific management plans ordered. Key interventions included templated EMR order text, job aid-guided order entry, provider redundancy, and automated calculations. The primary outcome measure, percentage of eligible patients with complete/correct plans, was plotted on a run chart.

Results Median weekly percentage of included patients with complete/correct patient-specific management plans increased from 0% to 83% within 4 months. Patients requiring intervention for urinary retention decreased from an average of 20% to 9%. No CAUTIs occurred before or after implementation.

Conclusions Utilizing quality improvement methods, we implemented a standardized approach to define and manage postoperative urinary retention. Standardization led to decreased interventions such as repeat catheterization for clinically insignificant retention.

Figure 2

Percent Foley removals in postop orthopedic patients.

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