Data Gap in Sacral Neuromodulation Documentation: Call to Improve Documentation Protocols

Abstract

Purpose: We quantified patient record documentation of sacral neuromodulation (SNM) threshold testing and programming parameters at our institution to identify opportunities to improve therapy outcomes and future SNM technologies.

Methods: A retrospective review was conducted using 127 records from 40 SNM patients. Records were screened for SNM documentation including qualitative and quantitative data. The qualitative covered indirect references to threshold testing and the quantitative included efficacy descriptions and device programming used by the patient. Findings were categorized by visit type: percutaneous nerve evaluation (PNE), stage 1 (S1), permanent lead implantation, stage 2 (S2) permanent impulse generator implantation, device-related follow-up, or surgical removal.

Results: Documentation of threshold testing was more complete during initial implant visits (PNE and S1), less complete for S2 visits, and infrequent for follow-up clinical visits. Surgical motor thresholds were most often referred to using only qualitative comments such as "good response" (88%, 100% for PNE, S1) and less commonly included quantitative values (68%, 84%), locations of response (84%, 83%) or specific contacts used for testing (0%). S2 motor thresholds were less well documented with qualitative, quantitative, and anatomical location outcomes at 70%, 48%, and 36% respectively. Surgical notes did not include specific stimulation parameters or contacts used for tests. Postoperative sensory tests were often only qualitative (80%, 67% for PNE, S1) with quantitative values documented much less frequently (39%, 9%) and typically lacked sensory locations or electrode-specific results. For follow-up visits, <10% included quantitative sensory test outcomes. Few records (<7%) included device program settings recommended for therapy delivery and none included therapy-use logs.

Conclusion: While evidence suggests contact and parameter-specific programming can improve SNM therapy outcomes, there is a major gap in the documentation of this data. More detailed testing and documentation could improve therapeutic options for parameter titration and provide design inputs for future technologies.

Keywords: Electronic health records; Implantable neurostimulators; Retrospective study; Urinary incontinence.

Fig. 1.

Patient sacral neuromodulation (SNM) care pathway and records analyzed. Records for 40 patients were reviewed and summarized for the SNM care pathway. A total of 127 visits were included. The number of visit records are shown in the parentheses for each clinical or surgical visit type. PNE, percutaneous nerve evaluation.

Fig. 2.

Sacral neuromodulation (SNM) motor threshold outcomes included in patient records. Within each surgery visit type, % of records including the test outcomes are shown. The number of surgical records is included in the parentheses. Zeros indicate no records included the outcome.

Fig. 3.

Sacral neuromodulation (SNM) sensory threshold outcomes included in patient records. Within each visit type, % of records including the test outcomes are shown. The number of records for each visit type is in parentheses. Zeros indicate no visit records included the outcome.