Title : Reducing discharge delays: Implementation of retro-grade bladder filling
Abstract:
As male to female gender affirming surgeries (GAS) such as vaginoplasty were added as a surgical procedure available at our facility, it was quickly apparent that the abundance of education and expectation fell on the day of discharge leading to delays and dissatisfaction for both patients and nursing staff. Vaginoplasty procedures are complex with an expected hospital length of stay of 5 days. Patients return to the post-operative unit with a stent in the vaginal canal, a urinary catheter, a drain, and a bolster dressing. On the day of discharge the expectation is that the bolster, stent, urinary catheter and drain are removed. The patient is instructed on how to dilate and then the patient waits until they are able to void on their own. This was found to add an average of 3-6 hours to the patient’s length of stay. Evidenced-based literature from gynecologic surgery demonstrate retro-grade bladder filling is a safe and effective intervention to assess the ability to void in a timely manner. With no literature for the GAS population a study proposal was submitted and approved by the lead surgeon in these procedures we began trialing this intervention. We utilized previous satisfaction surveys of patients and time to discharge of 25 patients undergoing vaginoplasty in the previous year (2020).This is a low volume surgery averaging 25 procedures a year at the time of the trial. There were no negative outcomes from this trial, and it has now become standard in our surgeon's practice. Data collection showed a decrease in length of stay by hours and the patient satisfaction scores were the same or slightly improved.
