Reducing the Incidence of Retained Double-J Ureteral Stents: A Multidisciplinary Approach

INTRODUCTION: Double-J® ureteral stents are temporary tubes used for ureteral patency that can cause serious complications if left beyond the allotted time. We developed a streamlined framework that allows for Double-J stent tracking to alert patients to the need for removal. METHODS: By creating a multidisciplinary committee we developed a database of patients with Double-J stents who presented to our facility between 2012 and 2014. The database was populated by a query of the billing system, generating HIPAA compliant stent removal reminder letters. Three queries (A, B and C) were developed using a combination of billing codes and each query was compared to a gold standard list. RESULTS: The ICD-9 ureteral catheterization code used to perform query A was only 28% sensitive. Query B (using CPT or HCPCS codes) was 98% sensitive. However, it incorrectly captured many patients with nonureteral stents. Our final query method, query C, rectified this issue by using the ICD-9 code with CPT or HCPCS codes, resulting in the highest sensitivity (78%) while minimizing undesired stent capture. CONCLUSIONS: We developed an automated and reproducible program that correctly identifies and alerts a high percentage of patients to the need to remove their stent. Repeated audits of our query methods combined with regular meetings of a multidisciplinary Double-J stent committee were integral to developing and maintaining this system. By promoting proactive awareness for patients as well as physicians, we are working to minimize the incidence of retained Double-J stents and associated complications.