Decreased Patient Driving Time, Gasoline Cost, and Carbon Emissions With an Institutional Home Foley Removal Quality Initiative

INTRODUCTION: A significant number of urogynecology patients are discharged with a Foley catheter for postoperative urinary retention. This requires subsequent catheter removal, traditionally completed in a healthcare setting. Randomized controlled trials comparing home Foley removal by patients to clinic removal have confirmed feasibility, non-inferiority, and similar satisfaction rates. OBJECTIVE: To implement a quality improvement (QI) initiative at our institution for opt-in home Foley removal after urogynecologic surgery and to assess the impact on complication rates, gasoline cost, and carbon emissions. METHODS: A prospective plan–do–study–act (PDSA) QI cycle was created for patients undergoing urogynecologic surgery. Preoperatively, patients were offered opt-in home Foley removal in the event of postoperative urinary retention. Patients were not offered home removal if their primary language was not English or if clinic removal was clinically indicated. Patients opting in were provided written and video instructions at their preoperative visit and at discharge with a Foley, with no formal teaching. Patients were instructed to remove their catheter 3–5 days after surgery, the same time frame as clinic removal, and to call the clinic if unable to void 5 hours after removal. Routine postoperative nursing phone calls were conducted on the intended day of removal with questions to assess success of Foley removal and voiding status. Patients unable to void following home removal received same-day clinic nursing appointments or were directed to the emergency room. After the first iteration of the QI initiative conducted over 5 months, we retrospectively collected data on demographics, type of removal indicated at preoperative visit, type of surgery, voiding parameters and voiding-related complications, driving times, cost of gas, and carbon emissions for all urogynecology postoperative patients discharged with a Foley catheter. We used T-test, Fisher's exact test, and Mann–Whitney test to compare home and clinic removal groups. RESULTS: From February 25 to July 31, 2025, 45 Urogynecology surgical patients were discharged with a Foley catheter for postoperative urinary retention, of whom 27 (60%) completed home Foley removal and 18 (40%) completed clinic Foley removal (Table 1). There was no significant difference between those completing home versus clinic removal for patient ability to void at time of removal, need for clean intermittent catheterization, need for catheter replacement, need for emergency room visit, or need for UTI treatment within 2 weeks of removal. Of patients completing home removal, 22 (81%) had zero nurse clinic visits, and of patients completing clinic removal, 2 (11%) had greater than one nurse visit. For patients who completed home removal without a nursing visit (n=22), median driving time saved was 37.5 minutes (IQR 20.0, 70.0), median cost of gas saved was $8.1 (IQR 3.1, 16.8), and median carbon emissions avoided were 24.0 kg (IQR 9.2, 49.8). CONCLUSIONS: Implementing an opt-in home Foley removal intervention for postoperative urinary retention in Urogynecology patients did not increase rates of clean intermittent catheterization, catheter replacement, emergency room visits, or UTI treatment within 2 weeks of Foley removal compared with patients who completed clinic Foley removal. Patients save driving time, gasoline costs, and carbon emissions with successful opt-in home Foley removal.Table 1Table 2