Abstract
Title:
Implementation of a Nurse-Led Perioperative Checklist to Optimize Same-Day Discharge After Aquablation for Benign Prostatic Hyperplasia
Author/Affiliation(s):
Janice K. Lavoie, MSN, APRN, AGPCNP-BC, AGACNP-BC, DNP candidate
Regina DeGennaro, DNP, CNS, RN, AOCN, CNL
University of Virginia School of Nursing
Background:
Aquablation is an emerging surgical treatment for benign prostatic hyperplasia (BPH) with a favorable safety profile and consistent improvements in symptom relief and patient satisfaction. Although institutional experience supports the feasibility of same-day discharge (SDD), routine overnight observation remains common due to workflow variability, inconsistent expectations, and communication gaps across perioperative settings. Nurse-led checklists improve standardization and interdisciplinary coordination; however, evidence in urologic pathways remains limited.
Purpose:
This quality improvement project evaluated whether implementation of a nurse-led perioperative checklist versus standard care improved clinical processes, increased SDD rates, decreased length of stay, and reduced procedure-related emergency department visits, hospital readmissions, and complications.
Methods:
Guided by Donabedian’s Structure–Process–Outcome model and Plan–Do–Study–Act cycles, a checklist was developed from retrospective analysis of over 1,200 Aquablation cases. Implementation spanned the Pre-Anesthesia Screening Services Clinic (PASS Clinic, Preoperative Holding, Post-Anesthesia Care Unit (PACU), and the Inpatient Surgical Unit. Nurse and physician champions supported adoption and adherence. Patient education was standardized across the perioperative settings, including integration into the electronic medical record using a SmartPhrase.
Findings:
Implementation improved workflow standardization, communication, and staff role clarity. Findings demonstrated increased SDD rates at 72%, with a target SDD rate of 75%. There were low rates of hospital readmission and emergency department visits, mostly related to expected postoperative catheter management and minor bleeding issues. There were no complications.
Conclusions:
A nurse-led perioperative checklist is a feasible, scalable strategy to support safe same-day discharge following Aquablation.
