title: Effect of establishing guidelines on appropriate urinary catheter placement.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, St. John Hospital and Medical Center and Wayne State University School of Medicine, Detroit, MI, USA. mohamad.fakih@stjohn.org
authors.forename: Mohamad G
authors.initials: MG
authors.lastname: Fakih
authors.forename: Margarita E
authors.initials: ME
authors.lastname: Pena
authors.forename: Stephen
authors.initials: S
authors.lastname: Shemes
authors.forename: Janice
authors.initials: J
authors.lastname: Rey
authors.forename: Dorine
authors.initials: D
authors.lastname: Berriel-Cass
authors.forename: Susan M
authors.initials: SM
authors.lastname: Szpunar
authors.forename: Ruth T
authors.initials: RT
authors.lastname: Savoy-Moore
authors.forename: Louis D
authors.initials: LD
authors.lastname: Saravolatz
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D002408:Catheters, Indwelling; D016009:Chi-Square Distribution; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D004282:Documentation; D004502:Education, Medical, Continuing / Q000458:organization & administration*; D004635:Emergency Medicine / Q000193:education / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D017053:Infection Control; D008485:Medical Audit; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D015397:Program Evaluation; D012189:Retrospective Studies; D019564:Unnecessary Procedures / Q000706:statistics & numerical data; D014546:Urinary Catheterization / Q000009:adverse effects / Q000706:statistics & numerical data*; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control