Reducing Inappropriate Urinary Catheter Use in the Emergency Department: Comparing Two Collaborative Structures

• Published in: Infection control and hospital epidemiology Vol. 39; no. 1; pp. 77 - 84
• Main Authors: Greene, M Todd, Fakih, Mohamad G, Watson, Sam R, Ratz, David, Saint, Sanjay
• Format: Journal Article
• Language: English
• Published: United States Cambridge University Press 01.01.2018
• Subjects: Catheter-Related Infections - prevention & control; Catheters; Catheters, Indwelling - statistics & numerical data; Collaboration; Cross Infection - prevention & control; Data collection; Education; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Feedback; Hospitals; Humans; Infections; Intervention; Medical instruments; Medical Overuse - prevention & control; Michigan; Nurses; Nursing; Patients; Program Evaluation; Regression Analysis; Sustainability; Urinary Catheterization - statistics & numerical data; Urinary Catheters - statistics & numerical data; United States > US; Michigan
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2017.256

BACKGROUND Urinary catheters, many of which are placed in the emergency department (ED) setting, are often inappropriate, and they are associated with infectious and noninfectious complications. Although several studies evaluating the effect of interventions have focused on reducing catheter use in the ED setting, the organizational contexts within which these interventions were implemented have not been compared. METHODS A total of 18 hospitals in the Ascension health system (ie, system-based hospitals) and 16 hospitals in the state of Michigan (ie, state-based hospitals led by the Michigan Health and Hospital Association) implemented ED interventions focused on reducing urinary catheter use. Data on urinary catheter placement in the ED, indications for catheter use, and presence of physician order for catheter placement were collected for interventions in both hospital types. Multilevel negative binomial regression was used to compare the system-based versus state-based interventions. RESULTS A total of 13,215 patients (889 with catheters) from the system-based intervention were compared to 12,104 patients (718 with catheters) from the state-based intervention. Statistically significant and sustainable reductions in urinary catheter placement (incidence rate ratio, 0.79; P=.02) and improvements in appropriate use of urinary catheters (odds ratio [OR], 1.86; P=.004) in the ED were observed in the system-based intervention, compared to the state-based intervention. Differences by collaborative structure in changes in presence of physician order for urinary catheter placement (OR, 1.14; P=.60) were not observed. CONCLUSIONS An ED intervention consisting of establishing institutional guidelines for appropriate catheter placement and identifying clinical champions to promote adherence was associated with reducing unnecessary urinary catheter use under a system-based collaborative structure. Infect Control Hosp Epidemiol 2018;39:77-84.