Development, Implementation, and Impact of an Electronic Medical Record Alert System for Implanted Artificial Urinary...

Area of Science:

• Urology
• Medical Informatics
• Patient Safety

Background:

• Artificial urinary sphincters (AUS) can be overlooked, leading to inadvertent catheterization and cuff erosion.
• Such complications necessitate explantation and can cause significant patient harm.
• A proactive electronic alert system is needed to mitigate these risks.

Purpose of the Study:

• To develop and evaluate an electronic medical record (EMR) best practice advisory (BPA) to alert clinicians to the presence of an artificial urinary sphincter.
• To assess the impact of this BPA on patient outcomes, specifically explant and erosion rates.
• To determine if the BPA reduces instances of erosion preceded by inadvertent catheterization.

Main Methods:

• A hard-stop BPA was implemented in the EMR to flag patients with an artificial urinary sphincter.
• Data on explants, erosions, and catheterization-related erosions were collected for men with AUS between August 2016 and September 2023.
• Incidence rates before and after BPA implementation were compared using statistical analysis (Poisson distribution).

Main Results:

• The BPA successfully identified patients with AUS, firing 2425 times.
• A significant reduction in explants was observed after BPA implementation (0.6 to 0.1 per exposure year, P = .01).
• Cuff erosions decreased significantly (0.04 to 0.01 per exposure year, P = .02), with no cases of erosion preceded by inadvertent catheterization occurring post-implementation.

Conclusions:

• The developed electronic advisory is an effective tool for enhancing patient safety in individuals with artificial urinary sphincters.
• The BPA significantly reduces the incidence of device explants and cuff erosions.
• The system successfully prevented erosions associated with inadvertent catheterization, highlighting its clinical utility.