Development and Validation of the Stent Tracking Algorithm Registry for Monitoring and Retrieving Forgotten Ureteral Stents

Abstract

Purpose: Forgotten ureteral stents are associated with safety issues, increased cost, and medicolegal disputes. Tracking ureteral stents is cumbersome because of the variety in placement periods. We developed and validated an electronic medical record (EMR) system-based algorithm for monitoring patients with ureteral stent placements. Materials and Methods: The Stent Tracking Algorithm Registry (STAR) is automatically activated once the physician enters the stent placement or replacement billing code into the EMR billing system. At 120 days, an overdue notification is generated and sent to the attending physician through an EMR pop-up dashboard and e-mail. The model is automatically deactivated when the stent of the corresponding laterality is removed. To validate the feasibility of STAR, we performed a retrospective review of 2194 patients who received stent placements between November 2006 and September 2019. Results: Among 2194 patients, STAR retrospectively identified 354 (16.1%) patients suspected of harboring forgotten ureteral stents. A total of 12 (0.5%) patients actually had forgotten ureteral stents and were contacted for removal. A total of 124 (5.7%) patients were identified because of the omission of the stent removal billing code, whereas 209 (9.5%) patients were identified because of being lost to follow-up after referral to another health care facility or death. There were no cases in which STAR identified patients whose stents were removed or replaced at an appropriate time frame. Conclusions: STAR provides an efficient interface with which to prevent the occurrence of forgotten ureteral stents. This model can be integrated into any EMR system that utilizes coding algorithms.