Page 5 - CUA 2020_Technology and Training_v2

Moderated Posters 5: Technical Advances in Urology, Improving Patient Relations

would improve accessibility to flexible cystoscopy in international settings clinical environment. In order to improve this process and reduce undue
by obviating the need for expensive tower equipment. stress, this work investigates the causes of worry in the perioperative
References process, as well as supporter-staff dynamics in a breadth of surgeries.
2. Shah J. Endoscopy through the ages. BJU Int 2002;89:645-52. Methods: A survey was administered to family and friends in the Surgical
https://doi.org/10.1046/j.1464-410X.2002.02726.x Family Waiting Room at Vancouver General Hospital (n=80). The survey
3. Phan YC, Cobley J, Mahmalji W. Cost analysis and service delivery consisted of questions regarding the respondents’ relation to the patient,
on using Isiris α to remove ureteric stents. J Endolum Endourol the surgical procedure taking place, and anxiety levels. Causes of such
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2018;1:e3-16. https://doi.org/10.22374/jeleu.v1i1.5 anxiety were explored, as was communication with the healthcare team.
4. Ibbotson S, Dettmer T, Kara S, et al. Eco-efficiency of disposable and Results: Most participants were waiting during what they perceived to be
reusable surgical instruments-a scissors case. Int J Life Cycle Assess a major surgery (84%, n=67). Most frequently reported causes of worry
2013;18:1137-48. https://doi.org/10.1007/s11367-013-0547-7 included morbidity and mortality (71%, n=57) and logistics regarding the
patient’s location, status, and surgical timeline (21%, n=17). The major-
MP-5.4 ity reported less than three visits to the nursing station (82%, n=59),
with 30% (n=24) reporting hesitancy in approaching staff for updates.
Clinical validation of an audio-based uroflowmetry app in adult The types of questions participants had were centered around logistics,
males procedural status, and timeline. When prompted on how communication
Mark Dawidek , Rohit Singla , Louisa Ho , Lucie Spooner , Christopher could be improved, more frequent updates during surgery were desired
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Y. Nguan 1,2 (44%, n=35).
1 Department of Urologic Sciences, University of British Columbia, Conclusions: There is a clear need for improved communication between
Vancouver, BC, Canada; MD/PhD Program, Faculty of Medicine, the healthcare team and patient supporters in order to properly address
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University of British Columbia, Vancouver, BC, Canada the anxiety they experience. Providing more frequent updates, having an
Introduction: Uroflowmetry is a common test for evaluating void- improved understanding of the perioperative period, and gaining better
ing by measuring urine flow directly. “Sonouroflowmetry” is a novel access to the surgical team are all avenues to ease their stress. Future work
approach that determines urine flow from acoustic measurement alone. will involve determining the feasibility of a communications platform to
Available as a software app on mobile devices, it is low-cost and por- address these identified gaps.
table. It has potential for screening and monitoring common urological
pathologies, particularly in out-of-office environments. This study is the
first to robustly evaluate sonouroflowmetry in a clinical setting against MP-5.6
the gold standard. Use of multimedia in postoperative patient education: A quality
Methods: Adult male patients (n=69) attending a general urology clinic improvement initiative
were recruited. Sonouroflowmetry was performed using the publicly avail- Ailsa Gan , Luke Witherspoon , Rodney H. Breau , Ranjeeta Mallick , Ilias
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able Uroflow Tracings (Traders Micro, Montreal, QC) app. Conventional Cagiannos , Christopher G. Morash , Luke T. Lavallée 1
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uroflowmetry was performed using the Urocap IV Uroflowmeter (Laborie, 1 Department of Surgery, Division of Urology, University of Ottawa,
Brossard, QC). MATLAB (MathWorks, Natick, MA) was used to extract Ottawa, ON, Canada
flow curve data. Bland-Altman analysis was used to compare perfor- Introduction: Variation in the discharge process has been found to
mance with respect to max flow, time to max flow, and total voiding increase discharge times and decrease quality of care. This quality
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time. Symmetric mean absolute percentage error (SMAPE) was used to improvement study examined if a multimedia-based resource could
quantitively compare curve shapes. decrease late discharges after robotic prostatectomy (after 2 pm on post-
Results: The correlation coefficient for max flow was 0.25 (p=0.04). This operative day 1) to <25%.
increased to 0.41 (p<0.001) when normalized by the voided volume, with Methods: From April 2018 to October 2019, all patients undergoing
limits of agreement (LoA) -123% and -17%. Correlation for time to max robotic-assisted radical prostatectomy (RARP) were asked to complete an
flow was 0.61 (p=0.002) with LoA -120% and 165%. Correlation for total anonymous survey using Likert scales evaluating the perioperative experi-
voiding time was 0.92 (p<0.001) with LoA -41% and 38%. The SMAPE ence. The quality improvement (QI) intervention started in March 2019.
for curve shape was 32.7% (standard deviation 14%), corresponding to A series of six educational videos were shown via an iPad to all patients
an accuracy of 67.3%. undergoing RARP. The videos were used to supplement postoperative
Conclusions: Sonouroflowmetry was inconsistent in evaluating flow mag- instruction prior to discharge. The discharge times of all patients were
nitude. This is attributable to high variability and difficult standardization obtained from The Ottawa Hospital Data Repositories derived directly
for acoustic signals. Performance improved with respect to temporal vari- from the electronic medical record. A Student’s t-test was used to com-
ables. The curve shape was surprisingly concurrent, both subjectively and pare mean discharge time (primary outcome). A run chart analysis was
objectively. Further work evaluating intra-patient reliability and pathology- used to detect change in discharge time (QI outcome measure). Patient
specific performance is required to fully evaluate sonouroflowmetry as a satisfaction and experience (QI balancing measure) was analyzed using
screening or monitoring tool. chi-squared analysis.
Results: A total of 347 robotic prostatectomies (199 pre-intervention, 148
MP-5.5 post-intervention) were available. Mean discharge time was not signifi-
cantly reduced in the intervention group compared to non-intervention
Causes of anxiety surveyed in patient supporters during the group (2:14 pm vs. 2:37 pm; p=0.12). Analysis of the run chart revealed
perioperative process that no rules were met to provide evidence for non-random change (Fig.
Keesha Khehra , Liz Burden , Rohit Singla , Angela Cho , Christopher 1). A total of 140 surveys (59 pre-intervention, 81 post-intervention) were
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Y. Nguan 4 completed, corresponding with a response rate of 29.6% and 54.7%,
1 MD Undergraduate Program, Faculty of Medicine, University of British respectively. Median score on a 10-point scale for overall satisfaction was
Columbia, Vancouver, BC, Canada; MD/PhD Program, Faculty of equal between the intervention and non-intervention groups (9 [inter-
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Medicine, University of British Columbia, Vancouver, BC, Canada; School quartile range (IQR) 8–10] vs. 10 [IQR 8–10]; p=0.92). There were no
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of Biomedical Engineering, University of British Columbia, Vancouver, differences in scores for anxiety at discharge, postoperative care, and
BC, Canada; Department of Urologic Sciences, University of British completeness of postoperative instruction between groups.
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Columbia, Vancouver, BC, Canada Conclusions: Use of multimedia resources did not reduce discharge times
Introduction: The perioperative process proves to be an anxiety- and after robotic prostatectomy in this study. Patient perception of care and
stress-inducing ordeal for not only the patients, but their family and friends education is high and was not negatively impacted when postoperative
as well. While their loved one is undergoing a surgical procedure, patient instruction was delivered using multimedia resources.
supporters are left in uncertainty while having to navigate an unfamiliar
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S105