PERFORMANCE IMPROVEMENT (PI) MONITORING

POPULATION OF INTEREST

1. All patients with GU injury (kidney, ureter, bladder, testicles/ovaries, penis, external genitalia)
2. All trauma patients with hematuria.

INTENT (EXPECTED OUTCOMES)

1. All patients in the population of interest have a documented GU exam (e.g., presence/absence of blood in urethral meatus, ecchymosis/bruising in perineum, high-riding prostate).
2. Patients with renal trauma undergo attempted renal salvage unless hemodynamically unstable.
3. Patients with hematuria are evaluated for GU injury (if stable, obtain imaging when available, surgical exploration if unstable).
4. When available, patients with blunt trauma, pelvic fracture, and hematuria are evaluated for bladder injury with cystography.
5. Patients with suspected urethral injury or blood at the meatus undergo retrograde urethrography.
6. A suprapubic catheter is placed for patients with identified urethral injury on retrograde urethrography or suspected urethral injury when urethrography is not available.

PERFORMANCE/ADHERENCE METRICS

1. Number and percentage of patients in the population of interest with documented GU exam.
2. Number and percentage of patients undergoing nephrectomy at Role 2 or Role 3.
3. Number and percentage of trauma patients with hematuria evaluated for GU injury (if stable, obtain imaging when available, surgical exploration if unstable).
4. Number and percentage of patients with blunt trauma, pelvic fracture, and hematuria evaluated for bladder injury with cystography.
5. Number and percentage of patients with suspected urethral injury or blood at the meatus who undergo retrograde urethrography.
6. Number and percentage of patients with suprapubic catheter placement for suspected or identified urethral injury.

DATA SOURCE

- Patient Record
- Department of Defense Trauma Registry (DoDTR)

SYSTEM REPORTING & FREQUENCY

The above constitutes the minimum criteria for PI monitoring of this CPG. System reporting will be performed annually; additional PI monitoring and system reporting may be performed as needed.

The JTS Chief and the JTS PI Branch will perform the systems review and data analysis.

RESPONSIBILITIES

The trauma team leader is responsible for ensuring familiarity, appropriate compliance, and PI monitoring at the local level with this CPG.