Mp03-05 Development, Implementation, and Impact of an Electronic Medical Record Alert System for Implanted Artificial Urinary Sphincters

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Male Incontinence (MP03)1 May 2024MP03-05 DEVELOPMENT, IMPLEMENTATION, AND IMPACT OF AN ELECTRONIC MEDICAL RECORD ALERT SYSTEM FOR IMPLANTED ARTIFICIAL URINARY SPHINCTERS Dylan Buller, Philip Olson, Maria Antony, Jennifer Lindelof, Ilene Staff, Tara McLaughlin, Joseph Tortora, Kevin Pinto, Laura Olivo Valentin, Fadi Hammami, Jared Bieniek, and Richard Kershen Dylan BullerDylan Buller , Philip OlsonPhilip Olson , Maria AntonyMaria Antony , Jennifer LindelofJennifer Lindelof , Ilene StaffIlene Staff , Tara McLaughlinTara McLaughlin , Joseph TortoraJoseph Tortora , Kevin PintoKevin Pinto , Laura Olivo ValentinLaura Olivo Valentin , Fadi HammamiFadi Hammami , Jared BieniekJared Bieniek , and Richard KershenRichard Kershen View All Author Informationhttps://doi.org/10.1097/01.JU.0001009488.55564.85.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The artificial urinary sphincter (AUS) is the gold standard surgical option for post-prostatectomy stress urinary incontinence. The presence of an implanted AUS may be overlooked due to a general lack of awareness, particularly outside of urologic contexts (e.g. emergency department, operating room). Inadvertent traumatic urethral catheterization without device deactivation can occur in these settings and may result in cuff erosion. A hard-stop best practice advisory was created in the electronic medical record to alert when any male patient with an implanted AUS presents for any surgical procedure, to a urology office, or an order is placed in any care setting for insertion of a urethral catheter. This AUS alert system (AUS-AS) was implemented on 4/25/2022. Here, we evaluate its utilization and impact on patient outcomes. METHODS: All AUS insertions, revisions, removal/replacements, and explants from 8/1/2016-9/30/2023 were analyzed. All re-operations were reviewed to identify cuff erosions directly preceded by catheterization through an activated AUS cuff. Event rates (e.g re-operations, explants, cuff erosions) in the pre-AUS-AS versus post-AUS-AS time frames were compared using cumulative device exposure years (EY) (i.e., total years of implant duration of all AUS devices in a given period) to account for differences in exposure time between the two time periods. Key variables were defined in SPSSv26 and compared using MedCalc's test of two rates based on Poisson distribution. RESULTS: 213 unique implants were identified in 194 patients (Table 1). The AUS-AS has fired 2,425 times since implementation, firing for a median of 36 unique patients per month. A total of 25 AUS explant cases occurred; 22 (.06/EY) pre-AUS-AS and 3 (.01/EY) post-AUS-AS (p=0.01). 19 out of 25 (76%) explants were due to cuff erosion. 10 out of 19 (53%) cuff erosions were directly preceded by catheterization through an activated cuff, all 10 (.03/EY) of which occurred prior to AUS-AS implementation (relative risk reduction 1.00, p=0.02). CONCLUSIONS: Since implementation of the AUS-AS, no patient required AUS explant due to cuff erosion secondary to trauma sustained during inadvertent catheterization. Our novel AUS-AS has strong implications for improving patient safety after AUS implantation. Source of Funding: Unfunded © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e23 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Dylan Buller More articles by this author Philip Olson More articles by this author Maria Antony More articles by this author Jennifer Lindelof More articles by this author Ilene Staff More articles by this author Tara McLaughlin More articles by this author Joseph Tortora More articles by this author Kevin Pinto More articles by this author Laura Olivo Valentin More articles by this author Fadi Hammami More articles by this author Jared Bieniek More articles by this author Richard Kershen More articles by this author Expand All Advertisement PDF downloadLoading ...