عنوان انگلیسی مقاله:
Implementation of a standardized voiding management protocol to reduce unnecessary re-catheterization - A quality improvement project
ترجمه فارسی عنوان مقاله:
اجرای یک پروتکل استاندارد مدیریت تخلیه برای کاهش دوباره کاتتریزاسیون غیر ضروری - یک پروژه بهبود کیفیت
Sciencedirect - Elsevier - Gynecologic Oncology 157 (2020) 487–493
Melissa Brackmann a, Erica Carballo b, Shitanshu Uppal a, Julie Torski a, R. Kevin Reynolds a, Karen McLean a,⁎
Objective. To design and implement a standardized postoperative voiding management protocol that accurately
identifies patients with urinary retention and reduces unnecessary re-catheterization.
Methods. A postoperative voiding management protocol was designed and implemented in patients undergoing
major, inpatient, non-radical abdominal surgery with a gynecologic oncologist. No patients had epidural
catheters. The implemented quality improvement (QI) protocol included: 1) Foley removal at six hours postoperatively;
2) universal bladder scan after the first void; and 3) limiting re-catheterization to patientswith bladder
scan volumes N150 ml. A total of 96 patients post-protocol implementation were compared to 52 patients preprotocol.
Along with baseline demographic data and timing of catheter removal,we recorded the presence or absence
of urinary retention and/or unnecessary re-catheterization and postoperative urinary tract infection rates.
Fishers exact test and students t-tests were performed for comparisons.
Results. The overall rate of postoperative urinary retention was 21.6% (32/148). The new voiding management
protocol reduced the rate of unnecessary re-catheterization by 90% (13.5% vs 2.1%, p = 0.01), without
overlooking true urinary retention (23.1% vs 20.8%, p = 0.83). Additionally, there was a significant increase in
hospital-defined early discharge prior to 11:00 AM (4.0% vs 22.0%, p = 0.022). There was no difference in the
postoperative urinary tract infection rate between the groups (p=1.00). Risk factors associatedwith urinary retention
included older age (p b 0.01), use of medications with anticholinergic properties (p b 0.01), and
preexisting urinary dysfunction (p b 0.01).
Conclusions. Implementation of this new voiding management protocol reduced unnecessary recatheterization,
captured and treated true urinary retention, and facilitated early hospital discharge
Keywords: Quality improvement | Bladder voiding | Urinary retention | Postoperative management | Gynecologic Oncology surgery | Urinary tract infection