Presented at the Society of Healthcare Epidemiology of America 19th Annual Scientific Meeting, San Diego, CA, March 2009.
Effect of Establishing Guidelines on Appropriate Urinary Catheter Placement
Article first published online: 1 MAR 2010
© 2010 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 17, Issue 3, pages 337–340, March 2010
How to Cite
Fakih, M. G., Pena, M. E., Shemes, S., Rey, J., Berriel-Cass, D., Szpunar, S. M., Savoy-Moore, R. T. and Saravolatz, L. D. (2010), Effect of Establishing Guidelines on Appropriate Urinary Catheter Placement. Academic Emergency Medicine, 17: 337–340. doi: 10.1111/j.1553-2712.2009.00677.x
The authors are grateful for the financial support by a Blue Cross Blue Shield of Michigan Foundation grant 1270.II.
- Issue published online: 1 MAR 2010
- Article first published online: 1 MAR 2010
- Received August 11, 2009; revision received September 17, 2009; accepted September 18, 2009.
- urinary catheterization;
- emergency hospital service;
- medical education
Objectives: Avoiding placement of unnecessary urinary catheters (UCs) in the emergency department (ED) affects UC utilization during hospitalization. The authors sought to evaluate the effect of establishing institutional guidelines for appropriate UC placement coupled with emergency physician (EP) education on UC utilization.
Methods: Urinary catheter utilization was measured before and after the establishment of guidelines and EP education. Data collected included the presence of a UC on ED arrival, placement of a UC in the ED, documentation of a physician order for UC placement, reasons for placement, and compliance with the guidelines. Chi-square analyses were used to study the association between pre- and postintervention time periods and catheter use.
Results: A total of 377 (15%) patients had UCs; only 151 (47%) UCs initially placed in the ED had a physician order documented. UC placement was appropriately indicated in 75.5% of patients with a documented physician order, but in only 52% of cases without a documented physician order (p < 0.001). The physician intervention was associated with an overall reduction in UC utilization from 16.4% to 13% (p = 0.018). Physicians ordered 40% fewer UCs postintervention compared to preintervention. Preintervention, a physician order for UC placement was found indicated in 72.6% patients, compared to 82.2% patients with UC placed postintervention (p = 0.21).
Conclusions: Establishing guidelines for UC placement and physician education in the ED were associated with a marked reduction in utilization. However, addressing appropriate UC utilization may require evaluating other factors such as nursing influence on utilization.
ACADEMIC EMERGENCY MEDICINE 2010; 17:337–340 © 2010 by the Society for Academic Emergency Medicine