Physician responsibility for removal of implants: the case for a computerized program for tracking overdue double-J...

Ureteral stents are used in various modern urologic procedures. Although forgotten double-J (JJ) stents are an infrequent problem, they are associated with significant medical problems. Encrustation from excessive indwelling time increases morbidity and may require extracorporeal shock wave lithotripsy to free the coils of the cementing calcerous material. An effective system should be in place to ensure timely removal. The previously used "card" system not only is difficult to manage but has proved unreliable. We describe a computerized program that tracks JJ stents and alerts physicians about stents that need removal.

Two hundred eighteen patients who were stented between January 1997 and December 1998 were tracked through an integrated computerized program. This program keeps a log of all patients who received a JJ stent and determines the last date by which it should be removed. Patients are reminded if they have not returned for removal of the implant 2 weeks before it is overdue.

Two hundred twenty-five JJ stents were placed in 218 patients. Comparison of data between the periods before and after computer program inception showed that the incidence of stents retained longer than their expiration time decreased from 12.5% to 1.2% in the first year of the program and 1.5% in the second year of the program.

Forgotten implants pose a significant management dilemma for physicians. Our tracking program significantly lowered the incidence of overdue JJ stents from 12.5% to 1.2% and 1.5% in the first and second years, of the program respectively (p = .00039). We propose that this technically simple program should be in place for all implants placed in patients. The problems we encountered in the smooth running of this system could be averted by incorporating several recommendations.