Presented by: Adib Rahman
Toowoomba Hospital

Introduction

Following urological procedures, it is common practice to utilise postoperative indwelling catheters (IDCs) that require a subsequent trial of void (TOV) before patients can be discharged. The necessity for extensive nursing care during this process can result in delays in initiating the TOV and overall discharge, particularly in hospitals with heavy workloads and limited staff. To address this issue, our hospital's urological team introduced a protocol, which involved the removal of IDCs during ward rounds when deemed appropriate based on clinical assessment. The primary objective of this study was to evaluate the effectiveness of this protocol in reducing the length of hospital stay (LOS) and expediting the discharge process. Additionally, the study aimed to examine any potential differences in complications or readmission rates as secondary outcomes.

Materials

In 2022, a prospective study was conducted at a regional hospital that specialises in urology care. The study enrolled patients who underwent transurethral resection of the prostate (TURP), transurethral resection of bladder tumour (TURBT), or bladder neck incision (BNI) procedures, wherein the standard practice involved placing indwelling catheters (IDCs). The data obtained from the intervention group was then compared to retrospective data from the same period in 2021. Various factors including age, BMI, ASA score, operation duration, length of hospital stay (LOS), complications, and readmissions were recorded and subjected to statistical analysis.

Results

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The two groups exhibited similarity, with the exception of BMI. The intervention group displayed an average length of hospital stay (LOS) of 55.98 hours (range: 24.5-126.75), whereas the non-intervention group had an average LOS of 61.11 hours (range: 24.25-125). However, this disparity did not yield statistical significance (p=0.238). In terms of postoperative outcomes, the intervention group experienced three complications and two readmissions, while the non-intervention group encountered five complications and five readmissions.

Conclusion

The findings of this study revealed a noteworthy and clinically meaningful decrease in the length of hospital stay (LOS) by 5.14 hours among patients who underwent the implemented protocol. This reduction has the potential to enable earlier discharge and enhance the overall flow of the hospital. Notably, the new protocol did not exhibit any substantial influence on complications or readmission rates. These findings emphasise the impact of a straightforward intervention on the discharge process following urological procedures.

Funding

Nil

Lead Authors

William Harrison, MBBS, B MSci
QLD Health

Co-Authors

Devang Desai, MBBS, FRACS
QLD Health