Pd62-10 Drivers of Preventable Emergency Department Visits in Urology: Using the Model for Improvement as a Framework to Learn

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety III (PD62)1 May 2024PD62-10 DRIVERS OF PREVENTABLE EMERGENCY DEPARTMENT VISITS IN UROLOGY: USING THE MODEL FOR IMPROVEMENT AS A FRAMEWORK TO LEARN Kathy H. Huen, Anthony Bettencourt, Jonathan Bergman, and Christopher S. Saigal Kathy H. HuenKathy H. Huen , Anthony BettencourtAnthony Bettencourt , Jonathan BergmanJonathan Bergman , and Christopher S. SaigalChristopher S. Saigal View All Author Informationhttps://doi.org/10.1097/01.JU.0001008656.89655.67.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Preventable emergency department (ED) visits are a significant source of waste in healthcare. Using the Institute for Healthcare Improvement's Model for Improvement (MFI), we aim to identify opportunities to reduce preventable ED visits in postoperative urological patients. METHODS: We reviewed all urologic surgeries at a tertiary academic institution between 1/2022-1/2023. We defined a preventable ED visit as occurring within 90 days after surgery, where the patient's disposition was home with neither imaging nor urologic consultation obtained. To understand improvement opportunities, we used a "drill down" approach, creating rational subgroupings on a Shewart chart, stratifying by: 1) day of the week; 2) time of day at presentation; 3) urology subdivision. A Pareto chart of representative chief complaints was used to identify drivers to the ED. We used semi-structured interviews to understand patient motivations. RESULTS: 4321 surgeries and 818 postoperative ED visits were included. 23% of postoperative ED visits were preventable. Drill down analysis revealed that a higher baseline of preventable ED visits occurred from midnight to 8am as compared to other times of the day (Figure 1). The major causes of preventable visits were catheter malfunctions, urinary retention, and nephrostomy tube malfunctions (Figure 2). Common themes from patient interviews included the "panic" felt with catheter malfunction and uncertainty about capabilities of ED alternatives (eg. immediate care clinic). We used these quantitative and qualitative data to create a theory-based approach to drive improvement, organized in a driver diagram (Fig 3). CONCLUSIONS: Using the MFI, we identified actionable drivers of preventable ED visits to inform future implementation of interventions. Download PPTDownload PPTDownload PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1289 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Kathy H. Huen More articles by this author Anthony Bettencourt More articles by this author Jonathan Bergman More articles by this author Christopher S. Saigal More articles by this author Expand All Advertisement PDF downloadLoading ...