Novel Hematuria Guidelines-Based Documentation Template, A Quality Improvement Project

Thursday, September 21, 2023

3:20 PM – 3:30 PM CT

Location: Avenue Ballroom, 4th Floor

Member Speaker(s)

Michael L. Smith, DO

Resident Physician
Franciscan Health Olympia Fields
Franciscan Health Olympia Fields

Disclosure(s): No financial relationships to disclose

Slides

Disclosure(s):

Michael L. Smith, D.O.: No financial relationships to disclose

Learning Objectives:

describe a more efficient documentation strategy regarding the updated 2020 AUA Guidelines on Microscopic Hematuria.
better understand the impact of the Microscopic Hematuria guidelines on patient risk stratification.
list the outcomes of patients screened utilizing the novel documentation tool for microscopic hematuria.

Introduction/Purpose:

New Urologic guidelines affecting clinical practice are constantly emerging based on new evidence. The AUA Microhematuria Guidelines were recently updated in 2020, and major changes include risk stratification into high, intermediate, or low risk groups. These groups are based on a combination of laboratory values and physical examination findings, however, rely heavily on information obtained during the patient interview (smoking history, chemical exposure, family history, etc.) An efficient method of incorporating these guidelines into clinical practice is through the use of electronic medical record templates, sometimes called dot-phrases. We present our experience with using an updated, guidelines-based documentation template that allows for risk stratification during the patient encounter.

Methods or Case Description:

100 patients were reviewed retroactively to determine resident compliance, and patient factors related the template that was used prior to the updated guidelines.

A new template was then constructed incorporating components of the 2020 AUA Guidelines on Microscopic Hematuria. Following the change in template, 94 patients were then seen in clinic and underwent evaluation utilizing the new hematuria guidelines-based template. These two groups were then compared with resident compliance rates, accuracy of risk stratification, and patient outcomes.

Outcomes:

Compliance with the new template was excellent among faculty/residents. Multiple questions such as smoking history, pack/year, and occupational exposures, were significantly better assessed with the updated template. Risk stratification level was documented in 91% of patients with the new template, and this was able to be conveyed to the patients during the same visit, increasing patient education and compliance with further diagnostic work-up.

Conclusion:

Creating a guidelines-based template can be an efficient way to document with complex guidelines such as the updated 2020 AUA Hematuria Guidelines. There was excellent compliance when the dot-phrase was incorporated into a residency clinic setting, and its’ use resulted in improved patient education on their individual risk level.