(Poster 77) Improving the Adequacy Rate of Uroflowmetry: A Quality Improvement Study

Objectives: Uroflowmetry is a noninvasive, inexpensive test that provides valuable information for urinary tract disorders and can assist in management strategies, often serving as an initial screening test for voiding dysfunction. Current guidelines recommend a minimum voided volume of 150 mL for proper interpretation, as smaller volumes can distort the shape of the flow curve. However, obtaining an adequate volume was often unfeasible in our facility, leading to a large number of inadequate uroflowmetry results. Furthermore, the majority of data used for interpretation is based on young nulliparous females in European populations rather than the typical urogynecologic patient.

The purpose of this study is to evaluate the effectiveness of a quality improvement initiative to increase the adequacy of uroflowmetry by increasing voided volume, as well as provide additional urine flow data for a more heterogenous cohort of patients. We hypothesize that the initiative will increase patient adherence and result in higher rates of adequacy with uroflowmetry.

Methods: A retrospective analysis of uroflowmetry results before and after the institutional implementation of a verbal reminder was performed at an outpatient academic tertiary care setting. Patients in the post-implementation cohort received a verbal reminder to present for the study with a “comfortably full bladder” in addition to standardized written instructions. After receiving IRB exemption, the electronic medical record was utilized to collect baseline characteristics of all patients as well as uroflowmetry results. The cohort of patients pre- and post-implementation was then compared utilizing independent samples t-tests for continuous variables and chi-square tests for categorical variables.

Results: A total of 44 patients were included in this study over a 12-month period, with 21 patients included pre-implementation and 23 patients post-implementation. The baseline characteristics were not statistically significantly different between the two groups, including a mean age of 56.76 ± 13.23 and 56.70 ± 15.53 (P=0.988) and a mean parity of 2.67 ± 1.96 and 2.43 ± 1.08 (P=0.625). Implementing a verbal reminder resulted in a statistically significant increase of voided volume from 120.02 ± 151.26 mL to 243.43 ± 198.84 mL (P=0.0265). This resulted in the number of studies being interpreted as “adequate” increasing from 28.6% to 73.9% (P= 0.0085), with no significant difference in post void residual, infection, or other complications. See Tables 1 and 2 for further comparisons.

Conclusions: A verbal reminder is a simple, cost-effective method to drastically improve the adequacy of uroflowmetry in the outpatient setting. Urine flow data from patients with heterogenous ages and ethnicities not classically represented in the literature is also presented here, although a larger patient population would be needed for adequate statistical comparisons to current nomograms.

Table 1. A comparison of baseline characteristics between cohorts
Table 2. A comparison of uroflowmetry results between cohorts