title: Use of an Electronic Medical Record to Assess Patient-Reported Morbidity Following Ureteroscopy.
abstract: OBJECTIVE
  With the extensive documentation afforded by our electronic medical record (EMR), we observed an unusually high number of patient-initiated encounters following ureteroscopy (URS). We sought to quantify and categorize patient encounters following URS to determine if we could identify avoidable common problems.
  
  
  METHODS
  Following IRB approval, we reviewed the records of 298 consecutive patients with stones who underwent 314 URS procedures between July 2013 and November 2014. Patient demographics, stone characteristics and operative details, as well as telephone encounters, secure online patient-initiated (MyChart) messages, and emergency department (ED) visits following URS were extracted from our EMR (Epic, Verona, WI). We performed univariate (UVA) and multivariate (MVA) analysis to identify factors predictive of postoperative patient encounters and compared URS patients to a group of 56 patients undergoing transurethral resection of bladder tumor (TURBT) for number and type of encounters.
  
  
  RESULTS
  We identified 443 encounters generated by 201 URS patients, including 334 telephone calls, 71 MyChart messages, and 38 ED visits. Among these encounters, 352 (79%) were medically related (pain comprised 45%) and the remainder involved scheduling issues. By UVA age, bilateral versus unilateral URS, stone location (both kidney and ureter), ureteral access sheath size, and total number of stones predicted a postoperative encounter. By MVA, only younger age and larger UAS size were independent predictors. When compared with TURBT patients, URS patients had a 2.5-fold higher risk of having a pain-related postoperative encounter (OR 2.54, 95% CI 1.08-7.04, P=0.03).
  
  
  CONCLUSIONS
  Among patients undergoing URS for stones, two-thirds made unprompted contact with a healthcare provider and 80% of contacts involved postoperative pain, a finding that is distinct from another endoscopic procedure that does not involve upper tract manipulation. Patients do not perceive URS as the benign procedure doctors do.
authors: 1 Methodist Hospital , Houston, Texas.
authors: Monica S C
authors: MS
authors: Morgan
authors: 2 Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas.
authors: Jodi A
authors: JA
authors: Antonelli
authors: 2 Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas.
authors: Yair
authors: Y
authors: Lotan
authors: 2 Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas.
authors: Nabeel
authors: N
authors: Shakir
authors: 2 Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas.
authors: Nicholas
authors: N
authors: Kavoussi
authors: 2 Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas.
authors: Adam
authors: A
authors: Cohen
authors: 2 Department of Urology, University of Texas Southwestern Medical Center , Dallas, Texas.|3 Charles and Jane Pak Center for Mineral Metabolism, University of Texas Southwestern Medical Center , Dallas, Texas.
authors: Margaret S
authors: MS
authors: Pearle
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007669:Kidney Calculi / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010146:Pain / Q000209:etiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000517:prevention & control*; D019233:Retreatment / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014514:Ureteral Calculi / Q000601:surgery*; D018666:Ureteroscopy / Q000009:adverse effects* / Q000295:instrumentation; D001749:Urinary Bladder Neoplasms / Q000601:surgery