Standardization of Postoperative Home Void Trial in Urogynecology Procedures: A Quality Improvement Project

INTRODUCTION: Home void trials have similar results to those performed in clinics. Despite the likelihood of decreasing healthcare burden, they are not yet universally adopted into practice. OBJECTIVE: The primary aim was to offer a standardized practice of postoperative home void trials for all urogynecology patients discharged with an indwelling catheter with the goal of reducing clinic void trials by 50%. The secondary aim was to measure phone calls and additional clinic visits regarding catheter management. METHODS: This was a quality improvement process involving patients undergoing urogynecologic procedures at a tertiary care center who were discharged home with an indwelling catheter. A universal, standardized home void trial protocol was implemented in January 2024. This involved providing patients with a handout preoperatively detailing the home void trial instructions and steps to schedule an urgent clinic assessment if they fail their home void trial. Surgeons and nursing staff were educated on this protocol at each hospital site. For patients needing clinic assessment, nursing staff were given a standardized protocol for clean intermittent catheterization (CIC) teaching. We retrospectively reviewed data 4 months prior to and after implementation of this protocol. The primary outcome abstracted from the electronic medical record was the number of void trial nursing visits prior to and after implementation. Additional outcome measures included the number of postoperative telephone calls, compliance with inclusion of the new standardized pre- and postoperative instructions in the after-visit summary, as well as rates of postoperative complications. RESULTS: A total of 113 patients were evaluated: 58 pre- and 55 post-implementation, respectively. Mean age was 64 ± 12 years. Procedure types were similar between groups and included minimally invasive sacrocolpopexy, sacrospinous ligament fixation, uterosacral ligament suspension, mid-vaginal repairs, retropubic and sling incision midurethral sling, hysterectomy, colpocleisis, fascial sling, and Burch colposuspension. Pre-implementation, 62% of patients had home void trials, compared to 96% post-implementation (p<0.01) (Table 1). The number of patients requiring at least one void trial nursing visit pre- and post-implementation was 46% vs 7%, respectively (p<0.01). There was no difference in the rate of postoperative urinary retention between groups: 4 in pre- and 5 in the post-implementation group. Of these, 8 were taught CIC, and 1 had prolonged Foley catheterization. Two patients in the post-implementation group experienced difficulty with contacting the clinic, resulting in an emergency department visit for retention. There was an increase in number of phone calls from a healthcare team member to the patient post-implementation (p=0.03), but there was no difference in the number of phone calls initiated from the patient (p=0.28) (Table 2). The overall rate of UTI was 24% in both groups. There was no significant difference in rates of other post-op complications. There was one patient in each group who required sling lysis for persistent urinary retention. CONCLUSIONS: The implementation of a standardized process for home void trials following urogynecologic surgery is a feasible and safe way to decrease the number of clinic visits. However, it is associated with increased phone call burden for the healthcare system.