Urinary Catheter Use and Appropriateness in U.S. Emergency Departments, 1995–2010

Authors

  • Jeremiah D. Schuur MD, MHS,

    Corresponding author
    1. The Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
    2. The Department of Medicine (Emergency), Harvard Medical School, Boston, MA
    • Address for correspondence: Jeremiah D. Schuur, MD, MHS; e-mail: jschuur@partners.org. Reprints will not be available.

    Search for more papers by this author
  • Jennifer Gibson Chambers MS,

    1. The University of New England, College of Osteopathic Medicine, Biddeford, ME
    Search for more papers by this author
  • Peter C. Hou MD

    1. The Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA
    2. The Department of Medicine (Emergency), Harvard Medical School, Boston, MA
    Search for more papers by this author

Errata

This article is corrected by:

  1. Errata: Errata Volume 21, Issue 6, 715, Article first published online: June 2014

  • Presented at the Society for Academic Emergency Medicine Annual Meeting, Chicago, IL, May 2012.
  • Dr. Schuur and Dr. Hou were supported by the Agency for Healthcare Research and Quality (R18HS020013). The authors have no potential conflicts of interest or other financial disclosures to report.

Abstract

Objectives

Catheter-associated urinary tract infection (CAUTI) is the most prevalent hospital-acquired infection, yet little is known about emergency department (ED) use of urinary catheters. The objective was to describe use of urinary catheters in U.S. EDs and determine the proportion that was potentially avoidable.

Methods

The National Hospital Ambulatory Medical Care Survey (NHAMCS), a weighted probability sample of U.S. ED visits, was analyzed from 1995 through 2010 for use of urinary catheters in adults. Use of a urinary catheter was a specific chart review element and was classified as potentially avoidable if none of the Centers for Disease Control and Prevention (CDC) list of appropriate indications were met by ED visit diagnoses or patient disposition. Annual frequency of urinary catheter use and appropriateness were calculated. Predictors of ED-placed urinary catheters for admitted patients were assessed with multivariate logistic regression.

Results

The annual rate of ED-placed urinary catheters varied from 2.2 to 3.3 per 100 adult ED visits. Among admitted patients, 8.5% (95% confidence interval [CI] = 8.0% to 9.1%) received urinary catheters; 64.9% (95% CI = 56.9% to 72.9%) were potentially avoidable. Among discharged patients 1.6% (95% CI = 1.5% to 1.7%) received urinary catheters. There was no significant trend over time in the use of urinary catheters or potentially avoidable urinary catheters (PAUCs). Predictors of catheter use in admitted patients included indicators of patient severity, female sex, and race/ethnicity. Hospital characteristics predicting catheter use included region, ownership type, and urban location. Predictors of potentially avoidable urinary catheter use were lower patient severity, female sex, care by a midlevel practitioner, and nonurban location.

Conclusions

Reducing use of urinary catheters outside of CDC guideline criteria in ED patients is a promising strategy to reduce CAUTIs.

Resumen

Objetivos

La infección del trato urinario asociada a sonda urinaria es la infección nosocomial más prevalente. No obstante, se conoce escasamente el uso de las sondas urinarias en el servicio de urgencias. El objetivo fue describir el uso de sondas urinarias en los SU y determinar el porcentaje de las potencialmente evitables.

Metodología

Se analizó el uso de sondas urinarias en adultos a través de la National Hospital Ambulatory Medical Care Survey, una muestra de probabilidad ponderada de las visitas a los SU de Estados Unidos desde 1995 a 2010. El uso de una sonda urinaria fue un elemento revisado específicamente en la historia clínica. El uso de la sonda urinaria se clasificó como potencialmente evitable si no cumplía ninguna de las indicaciones pertinentes de la lista según el diagnóstico de la visita al SU o la ubicación del paciente. Se calculó la frecuencia anual de uso de sonda urinaria y su pertinencia. Se evaluaron los factores predictivos de colocar una sonda urinaria en el SU para los pacientes ingresados mediante una regresión logística multivariable.

Resultados

El porcentaje anual de colocación de una sonda urinaria varió de 2,2 a 3,3 por 100 visitas de adultos al SU. En los pacientes ingresados, un 8,5% (IC95% = 8,0% a 9,1%) recibió una sonda urinaria; y un 64,9% (IC95% = 56,9% a 72,9%) fue potencialmente evitable. En los pacientes dados de alta, un 1,6% (IC95% = 1,5% a 1,7%) recibió una sonda urinaria. No hubo una tendencia significativa a lo largo del tiempo en el uso de sonda urinaria o en el uso potencialmente evitable. Los factores predictivos de sonda urinaria en los pacientes ingresados incluyeron indicadores de la gravedad del paciente, el sexo femenino y la raza/etnia. Las características del hospital que predicen el uso de sonda urinaria incluyeron la región, el tipo de pertenencia y la localización urbana. Los factores predictivos de sonda urinaria evitable fueron la menor gravedad del paciente, el sexo femenino, la atención por un profesional de nivel medio y la localización no urbana.

Conclusiones

La reducción del uso de sondas urinarias en pacientes que no cumplen los criterios de las guías clínicas de los Centers for Disease Control and Prevention es un estrategia prometedora para reducir las infecciones del tracto urinario asociadas con la sonda.

Ancillary