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.⇓⇓

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Figure 1

Key Driver Diagram.

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Figure 2

Percent Foley removals in postop orthopedic patients.