Avoiding Potential Harm by Improving Appropriateness of Urinary Catheter Use in 18 Emergency Departments - 19/05/14
, Michelle Heavens, MHA, BSN d, Julie Grotemeyer, BS d, Susanna M. Szpunar, DrPH, MPH b, Clariecia Groves, MS d, Ann Hendrich, RN, PhD dAbstract |
Study objective |
Urinary catheters are often placed in the emergency department (ED) and are associated with an increased safety risk for hospitalized patients. We evaluate the effect of an intervention to reduce unnecessary placement of urinary catheters in the ED.
Methods |
Eighteen EDs from 1 health system underwent the intervention and established institutional guidelines for urinary catheter placement, provided education, and identified physician and nurse champions to lead the work. The project included baseline (7 days), implementation (14 days), and postimplementation (6 months, data sampled 1 day per month). Changes in urinary catheter use, indications for use, and presence of physician order were evaluated, comparing the 3 periods.
Results |
Sampled patients (13,215) admitted through the ED were evaluated, with 891 (6.7%; 95% confidence interval [CI] 6.3% to 7.2%) having a catheter placed. Newly placed catheters decreased from 309 of 3,381 (9.1%) baseline compared with 424 of 6,896 (6.1%) implementation (Δ 3.0%; 95% CI 1.9% to 4.1%), and 158 of 2,938 (5.4%) postimplementation periods (Δ 3.8%; 95% CI 2.5% to 5.0%). The appropriateness of newly placed urinary catheters improved from baseline (228/308; 74%) compared with implementation (385/421; 91.4%; Δ 17.4%; 95% CI 11.9% to 23.1%) and postimplementation periods (145/158; 91.8%; Δ 23.9%; 95% CI 18% to 29.3%). Physician order documentation in the presence of the urinary catheter was 785 of 889 (88.3%), with no visible change over time. Improvements were noted for different-size hospitals and were more pronounced for hospitals with higher urinary catheter placement baseline.
Conclusion |
The implementation of institutional guidelines for urinary catheter placement in the ED, coupled with the support of clearly identified physician and nurse champions, is associated with a reduction in unnecessary urinary catheter placement. The effort has a substantial potential of reducing patient harm hospital-wide.
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| Supervising editors: Megan L. Ranney, MD, MPH; Debra E. Houry, MD, MPH |
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| Author contributions: MGF and MH conceived the study. AH obtained funding. MH and JG supervised the data collection and undertook recruitment of participating centers and managed the data, including quality control. MGF, SMS, and CG provided statistical advice on study design and analyzed the data. MGF drafted the article, and all authors contributed substantially to its revision. MGF takes responsibility for the paper as a whole. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/). The authors have stated that no such relationships exist and provided the following details: The study was undertaken by Ascension Health and was funded in part by the Centers for Medicare and Medicaid Services through the Partnership for Patients initiative. The analyses on which this publication is based were performed under contract HHSM-500-2012-00010C, Hospital Engagement Contractor for Partnership for Patients Initiative. |
Vol 63 - N° 6
P. 761 - juin 2014 Retour au numéro
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