Presentation Authors: Robin Djang*, Vernon Pais, Lebanon, NH
Introduction: Retained ureteral stents are classified as "never events" by the Centers of Medicare and Medicaid services. Stent registries have been implemented to prevent unintended stent retention, yet despite their proven effectiveness, patients continue to suffer from stents which remain in place for longer than intended. We assessed the incidence of retained ureteral stents despite implementation of an electronic stent registry and examined the root causes for registry failure.
Methods: A stent registry was developed utilizing Research Electronic Data Capture (REDCap), a secure web application. Patients are entered into the database using a combination of CPT codes for ureteral stent placement, removal, surgeon, and indication. REDCap account managers provide a list of patients with clinician billed stent removals monthly. Patients are cross-referenced with stent registry entries to remove patients and complete their records. Retained stents prompted manual review of the entire stent registry. Confirmed cases of stent retention requiring intervention for removal were documented in the database and contacted for intervention.
Results: A total of 1278 records were entered into the REDcap database from 4/9/2015 to 1/31/18 consisting of 1124 complete records (placement and extraction verified) with 154 pending records (stent extraction pending). 3 documented cases of retained stents requiring operative intervention were identified corresponding to an incidence of 0.24%. In one instance, a patient with bilateral ureteral stents was recorded appropriately, but only one stent was removed at office cystoscopy. The stent was found on cystoscopic evaluation of presumed bladder stone > 1 year later and the encrusted stent required cystolitholapaxy and percutaneous intervention. 2 patients did not experience stent discomfort and forgot they were in place and were detected after manual review of the stent registry.
Conclusions: Electronic ureteral stent registries are a validated, reliable method for tracking stent placement and removal. Human error in removing only one of bilateral stents and suboptimal patient understanding of need for stent removal resulted in retained stents. Systems remain limited by the potential for error imposed by those who build and maintain them. Therefore, stent registries are not a panacea and require diligent, meticulous upkeep and manual inspection to guarantee accuracy. An automated system without an alert mechanism is not better than a manual entry registry which is not monitored and can lead to a false sense of security.