Authors: (including presenting author): :
Kung WC(1), Chan KH(1), Mak MY(2), Lui KL(1), Sy YW(1), Hon WL(1), Lee KM(1), Yu MH(1), Li CM(1)
Affiliation: :
(1)Department of Surgery, Pamela Youde Nethersole Eastern Hospital
(2)Community Healthcare Services, Hong Kong East Cluster
Keyword 2: :
Quality and Safety
Keyword 3: :
Multidisciplinary
Keyword 4: :
Patient–Centered
Introduction: :
Percutaneous nephrostomy (PCN) is a crucial procedure for patients with ureteric obstruction, particularly those with advanced or inoperable malignancies receiving palliative care. Despite its importance, PCN related complications such as blockage, kinking, loose stitches, dislodgement, site infection, and leakage frequently lead to repeated hospital admissions, early catheter revisions, and reduced quality of life. Retrospective review in 1Q2025 revealed high complication and readmission rates, underscoring the need for a structured improvement initiative. This Continuous Quality Improvement (CQI) project aims to strengthen the safety and consistency of PCN management.
Objectives: :
• Enhance patient outcomes and comfort for individuals with PCN.
• Reduce complication rates and unplanned admissions, particularly blockage and dislodgement.
Methodology: :
The CQI project followed five phases: data collection, analysis, intervention development, implementation, and evaluation. A retrospective audit of 58 PCN related cases in 1Q25 showed 45 admissions for PCN revision, with blockage accounting for 68% of complications. High-frequency admissions were also analyzed to identify patterns and high risk patients. Based on these findings, targeted interventions were developed: patient and caregiver education via leaflets and videos; enhanced day ward enquiry systems; regular or PRN flushing by urology nurses and community nurses for high risk cases (Repeated admission within 30 days); catheter upsizing for recurrent blockage; and multidisciplinary reviews with radiologists, urologists, urology nurses and community nurse. Additional strategies addressed kinking (via stenting technique and improved fixation devices), loose stitches, and dislodgement through updated catheter choices and staff training.
Result & Outcome: :
Implementation across Q1–Q4 2025 demonstrated measurable improvements. Admissions due to PCN blockage decreased significantly, reduced 65% from 40 cases in Q1 to 14 cases in Q4, aided by consistent flushing and proactive catheter management. Dislodgement cases declined 40% reflecting better fixation and catheter selection. Loose stitch complications showed improved stability. Overall PCN related admissions demonstrated a downward trend with 52% reduction, and discharge rates from day ward improved from 64% to 89% with fewer transfers to inpatient ward, indicating successful prevention strategies. The project achieved meaningful enhancements in PCN care quality, patient safety, and complication reduction.
