PD38-10 AN INITIATIVE TO REDUCE DOOR TO INCISION TIME FOR PATIENTS WITH TESTICULAR TORSION

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety III (PD38)1 Sep 2021PD38-10 AN INITIATIVE TO REDUCE DOOR TO INCISION TIME FOR PATIENTS WITH TESTICULAR TORSION Justin Nguyen, Matthew Buck, Alejandro Abello, Marianne Casilla - Lennon, Michael Leapman, Adam Hittelman, Jason Teitelbaum, Beth Emerson, Jaime Cavallo, Patrick Kenney, and Sarah Lambert Justin NguyenJustin Nguyen More articles by this author , Matthew BuckMatthew Buck More articles by this author , Alejandro AbelloAlejandro Abello More articles by this author , Marianne Casilla - LennonMarianne Casilla - Lennon More articles by this author , Michael LeapmanMichael Leapman More articles by this author , Adam HittelmanAdam Hittelman More articles by this author , Jason TeitelbaumJason Teitelbaum More articles by this author , Beth EmersonBeth Emerson More articles by this author , Jaime CavalloJaime Cavallo More articles by this author , Patrick KenneyPatrick Kenney More articles by this author , and Sarah LambertSarah Lambert More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002048.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Time from symptom onset of testicular torsion to detorsion predicts likelihood of testicular salvage. We aimed to reduce time from door-to-incision to under 120 minutes at our institution. METHODS: We developed a streamlined process to prioritize suspected torsion cases, coordinating a multidisciplinary team including urology, emergency medicine, radiology, anesthesiology, perioperative services, and transport services. The Initial intervention involved rapid identification of suspected cases in the emergency room (ER), immediate parallel notification of urology and radiology for evaluation, case prioritization by perioperative services, and rapid assessment by anesthesiology. We subsequently implemented portable bedside ultrasound in the ER for all suspected torsion cases. We assessed the effects of the intervention with statistical X-mR process control charts and used Nelson rules to determine special cause. RESULTS: From January 2019 to February 2021, we observed 33 torsion events requiring surgical intervention, 15 before and 18 after the intervention. Following improvement efforts, mean door-to-incision time decreased from 221 minutes to 123 minutes. After the intervention there was a significant decrease in door to incision time through a shift of 8 patients below the control limit. We further identified a significant reduction in patient-to-patient variation through a shift of 8 in the moving range below the control limit. Compared to cases prior to our intervention time from arrival to ultrasound remained unchanged from 60 minutes to 62 minutes, and time from arrival to urology evaluation decreased from 135 minutes to 62 minutes, ultrasound duration decreased from 43 minutes to 36 minutes, and time from ultrasound to incision decreased from 157 minutes to 76 minutes. CONCLUSIONS: Implementation of multidisciplinary improvement work reduced door to incision time for patients with suspected testicular time. These interventions provide a reproducible model to improve efficiency in treating patients with testicular torsion. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e666-e666 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Justin Nguyen More articles by this author Matthew Buck More articles by this author Alejandro Abello More articles by this author Marianne Casilla - Lennon More articles by this author Michael Leapman More articles by this author Adam Hittelman More articles by this author Jason Teitelbaum More articles by this author Beth Emerson More articles by this author Jaime Cavallo More articles by this author Patrick Kenney More articles by this author Sarah Lambert More articles by this author Expand All Advertisement PDF downloadLoading ...