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• W4323539320 abstract "Rates of postoperative urinary retention (POUR) after Urogynecologic surgery can be up to 40%. Post operative trials of void (TOV) are utilized to screen for POUR and may be via active retrograde bladder filling or passive bladder filling after catheter removal. Meta-analyses have shown these methods have equivalent time to discharge and success rates. Our institution utilizes passive TOV and provides patients two attempts. However, volume cutoffs and timing were not standardized, and provider input was expected on each TOV result. This quality improvement initiative aimed to standardize TOV timing and cutoffs and reduce time needed to complete the TOV process in a two-attempt, passive TOV format. The initiative followed a Plan Do Study Act (PDSA) cycle (Figure 1). After noting inconsistencies in void trial criteria, timing, and documentation of results, we identified stakeholders from nursing, the ObGyn residency, and the Urogynecology division. Issues with void trials were discussed in stakeholder meetings and a formal TOV protocol was created (Figure 2). Protocols were posted in the PACU, resident workrooms, and available for online reference. Order sets were edited to align with the new process flow, and catheterization orders were included. Data was retrospectively collected from all women undergoing Urogynecologic surgery in the 3 months before and 5 months following protocol implementation, with a 30-day hiatus to allow for protocol uptake. Groups were similar in age, BMI, pre-operative voiding dysfunction, and surgical characteristics. Outcome results are summarized in Table 1. Following void trial implementation, overall adherence to the protocol increased from 60% to 72%, but median time to discharge was unchanged and overall rates of foley placement did not improve. Within the post intervention period, cases that adhered to protocol had no significant change in time from incision closure to discharge (6.75 vs. 8.72 hours), same day discharge (67% vs 52%), or UTI and had a significantly lower rate of foley placement compared to cases that deviated from protocol. Standardization of an existing postoperative void trial routine with a process flow and order set adhering to institution practices did not reduce time from incision closure to hospital discharge, despite increased adherence to the process flow. Further PDSA cycle iterations modifying the protocol are warranted to improve adherence to void trial protocols and decrease time to discharge and will specifically include a cost-effective analysis of second void trial attempt versus foley catheter placement after first failure.Tabled 1Void Trial Protocol OutcomesPre-ProtocolPost-ProtocolP valueTotalAdheredDeviatedTotalPre vs. post; adhered vs. deviatedMedian time until first void (min)164173180180.38; .30First void pass rate (%)61.5%52.7%14.3%42.1%.03; .02Discharge with foley catheter (%)15.4%14.5%23.8%17.1%.80; .90Median incision closure to discharge time (min)372405523408.52; .36Same day discharge (%)67%67%52%63%.63; .23Postop UTI (%)7.7%12.7%14.3%13.2%.45; .57 Open table in a new tab Process flow for postoperative trials of voidView Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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• W4323539320 date "2023-03-01" @default.
• W4323539320 modified "2023-09-27" @default.
• W4323539320 title "Improving efficiency of second void trials: a quality improvement initiative" @default.
• W4323539320 doi "https://doi.org/10.1016/j.ajog.2022.12.171" @default.
• W4323539320 hasPublicationYear "2023" @default.
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