Waching daily Jun 28 2018

General Surgery Nurse Care Coordinator...

Aggie - It's Tom Smith.

I had to go to the local emergency department last night, I couldn't urinate. They said I had POUR?

I'm so sorry.

Tom: I have this catheter in until you can get it out. They said it would come out in a week.

I'm not even sure how to wash with this.

I'm also worried am I going to be charged since I couldn't get to the VA ED? It was three hours away!

Mr Smith's condition is something called postoperative urinary retention or POUR

It happens when the bladder goes to sleep after anesthesia. POUR occurs in ~20% of high risk patients...

And can last up to two days.

However,

When POUR goes unrecognized

It leads to ED visits for urgent urinary catheterization and follow up visits with specialty care clinics and/or the ED.

Consequently, Catheters stay in place longer than necessary for a condition that resolves in two days. This leads to CAUTI.

You know Aggie, I'm so glad we designed innovations for POUR. I've been on PULSE and Listserve nationwide

POUR is a problem. People are not treating it effectively.

And the Veteran is caught in the middle.

Six VA's have contacted us.

They've all got different methods. They're all struggling. Some are even admitting to the hospital.

So what I find interesting is POUR is well documented in the literature

But there are few solutions offered for treating it in our system.

The San Diego POUR innovations toolkit includes...

An evidence based screening tool for POUR prior to discharge which includes a straight or indwelling catheter when necessary.

Improved process for follow-up care

If a catheter is inserted, discontinuation can be one of two ways. First option is by the Veteran

or their caregiver in their home. This is consistent with whole health.

The second is by appointment with the Veteran's PACT nurse within 2 - 4 days

Finally, patient education nursing tools are included.

In summary, we are standardizing care with our toolkit and a streamlined and innovative design.

Of the patient design between ambulatory surgery and follow-up care.

No longer are we calling these patients after surgery.

And then hearing that they were in distress and that they had to seek emergency treatment for POUR.

Effective POUR management preserves access to our urology clinic.

by NOT making appointments unneccesarily.

By preventing unnecessary specialty clinic appointments,

ED visits and CAUTI

We have a cost avoidance of more than 56 thousand dollars in six months

As compared to the pre-innovation.

Our societal value is due to preserving non VA care dollars for the Veteran who really needs them.

If I had received the catheter after the procedure,

I could have taken it out two days later at home or gone to see my primary care nurse

Our outcomes are positive as compared to three months prior to implementation.

We are six months into this pilot.

We no longer have ED visits or urology visits for POUR

There have been no incidents of CAUTI or hospital admissions

We are preserving specialty clinic access, ED use and preventing CAUTI

All which contributes to improved metrics in SAIL.

Ask us about San Diego VA's innovation because flow is imPOURtant!