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Engage with Quality Improvement and Patient Safety
(E-QIPS)
The Quality Improvement and Patient Safety (QIPS) Committee has a critical function to develop internal and external policy on quality and safety on behalf of the American Urological Association, its members, and the larger urological community. Although this core mission is vital, there remains a growing interest, need, and opportunity for direct engagement, support, and growth of the science and practice of quality improvement and patient safety by urologists and affiliated health care professionals.
To that end, we are excited to introduce a new section of curated, community-sourced content from the American Urological Association. The Engage with Quality Improvement and Patient Safety (E-QIPS) section will cultivate quality improvement and patient safety projects from members of the urological community to highlight QIPS accomplishments, foster QIPS growth, encourage collaboration, and elevate urological care.
We encourage all those in the urological community (physicians, advanced practice providers, nurses, researchers, patient advocacy groups, etc.) to contribute to future E-QIPS Guides and Works-in-Progress.
The E-QIPS Guides section provide a concise, step-by-step outline of proven urological practice improvement strategies that you can replicate and apply to your practice to potentially increase safety, efficacy, and efficiency of patient care.
- Using Lean Methodology to Increase Clinic Efficiency
This project used process mapping to identify waste in the current clinic flows to devise improvements in order to improve upon identified waste.
Andrew Harris, MD
Andrew.harrismd@uky.edu - Strategies to Optimize Nephrolithiasis Emergency (STONE) Care: Creation of an Emergency Department Clinical Pathway
We created a a clinical pathway and associated EHR order set for patients presenting to the Emergency Department (ED) with renal colic in an attempt to improve adherence to evidence-based imaging and clinical guidelines. Pathway and order set details, as well as project outcomes, have been published previously.
Dima Raskolnikov, MD
raskod@uw.edu - Non-Opioid Pathway Post Ureteroscopy and Ureteral Stent Placement
The goal of this project was to decrease the prescribing of opioid medications after ureteroscopic surgical interventions. We developed an algorithm where NSAIDS and other adjunct medications shown to improve stent related symptoms were used whenever possible instead of prescribing opioids. This involved a shift of practice and culture change for providers and was rooted in a focus on patient education and expectation setting.
Kevan Sternberg, MD
Kevan.sternberg@uvmhealth.org - Ureteroscopy Standardization and its Impact on Efficiency in the Operating Room
Ureteroscopy is a common urologic procedure with significant variability from one case to the next. With high turnover in ancillary operating room staff who may be less familiar with specifics of ureteroscopy, there is often significant wasted time spent in the operating room waiting for items to be located, accessed and opened. We implemented a process to standardize how ureteroscopic procedures are posted as well as coding products used during ureteroscopy in a way that makes them easier to locate.
Jordan Goldwag, MD; Laila Bangash, MHA, MBA; Andrew Harris, MD
Jgo285@uky.edu - The Procedure Based Telehealth Utilization Initiative
The Telehealth (TH) Utilization Initiative aims to improve rate of TH utilization for post-operative visits in surgical clinics. Targeting appropriate procedures, rather than patient preference, increases TH utilization thereby improving clinic efficiency and increasing revenue.
Brittany E. Levy MD and Andrew M. Harris, MD
Brittany.Levy@uky.edu -
The Time Out Engagement and Standardization Initiative
The Time out Engagement and Standardization (TOES) quality improvement initiative was developed to reduce the passive nature of the time out and increase engagement amongst all members of the surgical team.
Brittany E. Levy MD and Andrew M. Harris, MD
Brittany.Levy@uky.edu -
Improving Knowledge of Surveillance Practices in Non-muscle Invasive Bladder Cancer (NMIBC)
We displayed posters in our urology clinic and cystoscopy rooms at DHMC to improve provider and resident knowledge regarding guideline-recommended surveillance practices for NMIBC. This intervention resulted in a 22.4% and 28.9% increase the proportion of survey respondents who routinely discussed risk-aligned surveillance strategies with their patients and who performed guideline-recommended upper tract surveillance for high-risk disease, respectively.
Michael E. Rezaee, MD, MPH and Florian R. Schroeck, MD, MS
Michael.E.Rezaee@hitchcock.org -
Multi-Disciplinary Development and Implementation of a Trial of Void Algorithm to Standardize and Reduce Indwelling Urethral Catheter Use
Prolonged indwelling urethral catheter use is a risk factor for catheter-associated urinary tract infections (CAUTIs). Through a multi-disciplinary approach engaging members of CUIMC-Columbia nursing leadership and the Department of General Surgery, we created and implemented a novel evidence-based trial of void algorithm to standardize and reduce indwelling catheter use in post-operative patients.
David S. Han, MD, MS
dsh2154@cumc.columbia.edu
*2023 Residents and Fellows Competition Winner -
Standardization of Surgical Technician Handoffs Using a Visual Cognitive Aid
Observation of multiple handoffs between surgical technicians (ST)revealed there was no standard for information shared during these handoffs. We utilized lean methodology to engage frontline stakeholders, including all surgical technicians, to create a standardized handoff and communication tool in collaboration with the operating room (OR) quality improvement (QI) team.
Wesley Wilt, MD
wesley.stephens@uky.edu
*2023 Residents and Fellows Competition Winner
The E-QIPS Works-in-Progress section highlights the on-going commitment and involvement of our urological community in QIPS. Here you will find a list of urological practice improvement projects currently in progress that are available for multi-institutional collaboration.
- One Safe Act (OSA)
The “One Safe Act” initiative would generate discussion and dissemination of personal actions and behaviors that promote patient safety. The specific aims are to (1) facilitate interprofessional teaming of staff who work in a shared environment; (2) encourage self- and group-reflection of proactive behaviors done to ensure or promote patient safety; and (3) identify, catalog, and distribute learnings of common or universal proactive safety behaviors that can be adopted across the organization.
Justin B. Ziemba, MD MSEd
justin.ziemba@pennmedicine.upenn.edu - Urologists Provide Online Resource to Obstetric Hospital Multi-Specialty Staff Which Increases Agreement to Diagnose Newborns as "Suited to Circumcise"
Newborn circumcision is currently practiced routinely in obstetric hospitals by their staff as obstetricians and pediatric caregivers before newborn discharge. About 20% of such births show anatomic findings that categorize the boys as “not suited” to this routine.* However, these caregivers do not have a resource that guides how to make this determination. We provide an e-learning tool to fill the gap in such education which is accessible by computer, mobile devices and amenable to print out in hospital nurseries.
Max Maizels, MD
max.maizels@gmail.com - The Rosetta (Kidney) Stone Project
Reliable instructions after our common clinic-based procedures are not available or routinely implemented in our faculty-based clinic for patients with limited English proficiency. This project aims to create standardized written discharge instructions in our most commonly spoken non-English languages and make them easily available to patients following our most common clinic-based procedures.
Max Bowman, MD
max.bowman@ucsf.edu
*2023 Residents and Fellows Competition Winner - Effect of Educating Nurses on Difficult Foley Catheter Placement
We initiated a quality improvement project at our 881-bed private adult teaching hospital to teach all pre-operative and postoperative care unit (PACU) nursing staff how to place Coudé catheters, as well as how to troubleshoot difficult female catheter insertions. Moreover, nurses from multiple units in the hospital, including the operating room (OR), intensive care unit (ICU), floor, and emergency room (ER), were asked to volunteer to become ‘Superusers,’ who would be certified to help nursing colleagues in their respective units when they were unable to successfully place a catheter. We created an algorithm to help nurses know when to attempt Coudé catheter placement or call a Superuser.
Catherine Ingram, MD
cfingram@bcm.edu -
Reducing Preventable Emergency Department Visits in Benign Prostate Surgery through Implementation of Self-Irrigation of Catheters: Using the Model for Improvement as a Framework to Learn
We intend to implement a protocol of self-catheter irrigation in patients who have undergone benign prostate surgery (Transurethral Resection of the Prostate (TURP), Aquablation, Photo-Vaporization of Prostate, Holmium Laser Enucleation of the Prostate (HoLEP), Transurethral Incision of the Prostate (TUIP), and Urolift, among others) and who are discharged to home with an indwelling catheter. This will be facilitated by nursing staff who will teach patients how to self-irrigate their catheter prior to discharge. Our goal is to reduce emergency department visits related to foley catheters and improve the patient experience.
Anthony Bettencourt, BSN, Christopher Saigal, MD, MPH, and Kathy Huen, MD, MPH
abettencourt@mednet.ucla.edu
PLEASE NOTE: E-QIPS Guides and E-QIPS Works-in-Progress are provided as a service to AUA members and in the interest of publicizing and advancing quality improvement initiatives throughout the urologic community. AUA is not responsible or liable for the veracity, accuracy or timeliness of the information provided in individual E-QIPS Guide or E-QIPS Works-in-Progress submissions. No attempts have been made by the AUA to pre-screen projects, nor verify stated outcomes.
While E-QIPS Guides are intended to encourage best practices, they do not pre-empt physician judgment in individual cases. Treating physicians must take into account variations in resources, and patient tolerances, needs, and preferences. Conformance with any E-QIPS Guide or E-QIPS Work-in-Progress does not guarantee a successful outcome.
An E-QIPS Guide or E-QIPS Work-in-Progress submission may include information or recommendations about certain drug uses (‘off label‘) that are not approved by the Food and Drug Administration (FDA), or about medications or substances not subject to the FDA approval process. AUA urges strict compliance with all government regulations and protocols for prescription and use of these substances. The physician is encouraged to carefully follow all available prescribing information about indications, contraindications, precautions and warnings.
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