Optimizing Postoperative Active Bladder Trial Protocol Through Structured Intervention

INTRODUCTION: Postoperative urinary retention (POUR) is a common complication that can result in bladder over distention, patient discomfort, increased infection risk, catheter reinsertion, and delayed recovery. To assess voiding function prior to discharge, many institutions utilize the active bladder trial (ABT), due to its association with shorter hospital stay and higher patient satisfaction. POUR is reported in 15–45% of women after prolapse repair and in 2–25% following midurethral sling procedures, reflecting differences in surgical technique and concomitant interventions. Despite its advantages, ABT outcomes remain variable and are influenced by institutional protocols and nursing staff experience. At our institution, a review of ABT outcomes from August to December 2024 revealed a difference between two surgical settings at the same institution: the ambulatory surgery center (ASC) and the main medical center (MC). ABT pass rates were significantly higher at the MC (80%) compared to the ASC (47%), despite similar patient demographics and surgical procedures. Potential contributing factors included workflow constraints, inconsistent techniques, and limited nursing staff training. We hypothesized that a structured and targeted educational training session to postoperative nursing staff will reduce POUR. OBJECTIVE: To evaluate whether a structured educational intervention will improve ABT pass rates at the ASC. METHODS: This study employed a three-phase observational design: baseline assessment, intervention, and post-intervention evaluation. ABT outcomes were prospectively collected over a three-month period at both ASC and MC. A 30-minute PowerPoint standardized training session was taught at the monthly nursing staff meeting. The session included a review of pre-intervention pass rates at the ASC compared to the MC, risk factors for higher ABT failure, along with step-by-step instructions on correctly performing and interpreting the ABT. After the presentation, staff were invited to discuss system barriers or challenges they had encountered while caring for patients undergoing an ABT. They were given points of contact and encouraged to communicate with the surgical team about ABT results. The intervention emphasized consistent ABT technique, clear patient instructions, accurate assessment of voiding, and reliable measurement of post-void residual volume. Post-intervention ABT outcomes were prospectively collected over a subsequent three-month period using identical criteria. Chi-square analysis was used to compare pre- and post-intervention ABT failure rates at ASC. RESULTS: During the pre-intervention phase, 14 of 30 ABTs at ASC passed (47%) compared to 40 of 50 at MC (80%), a statistically significant difference (χ2=8.04, p=0.005). Following the educational intervention, ABT pass rates at ASC improved markedly to 22 of 30 (73%), representing a statistically significant improvement compared to the pre-intervention rate (χ2=4.17, p=0.041). Post-intervention outcomes at ASC (73% pass) closely mirrored those at MC (80% pass), indicating successful reduction of the performance gap. CONCLUSIONS: A structured educational intervention significantly improved ABT success rates in an outpatient surgery center. These findings underscore the importance of a simple, low-cost standardized training intervention and procedural consistency in optimizing postoperative voiding assessment and enhancing patient recovery. Implementing targeted education for nursing staff may be a key strategy in reducing POUR.Table 1Table 2Figure 1