title: Feasibility of audit and feedback to reduce postoperative urinary catheter duration.
abstract: BACKGROUND
  Indwelling urinary catheter duration is an important risk factor for catheter-associated urinary tract infections (CAUTIs).
  
  
  OBJECTIVE
  To audit patient-level postoperative catheter duration and measure the impact of its feedback to nursing staff on postoperative catheter duration and CAUTI rates.
  
  
  METHODS
  Preobservational and postobservational study.
  
  
  METHODS
  Two surgical units at an urban academic medical center.
  
  
  METHODS
  Postoperative patients with indwelling urinary catheters.
  
  
  METHODS
  Audit and feedback of postoperative urinary catheter duration to nurses during an educational session.
  
  
  METHODS
  Patient-level postoperative catheter duration obtained from electronic clinical documentation. Mean catheter duration and proportion of patients with postoperative catheter duration <3 days were determined.
  
  
  RESULTS
  Following the intervention, the mean postoperative catheter duration decreased (1.7-1.4 days [P = 0.01] on orthopedic surgery, and 2.6 to 2.2 days [P = 0.01] on general surgery). The proportion of patients with catheter duration <3 days increased significantly on orthopedic surgery (86-92% [P = 0.04]), and nonsignificantly on general surgery (56-63% [P = 0.14]). When adjusted for length of stay differences, the odds of catheter duration <3 days on general surgery increased from 1.38 (P = 0.14) to 1.69 (P = 0.02). The CAUTI rates did not significantly decrease. The rate on orthopedic surgery dropped from 8.9 infections per 1000 device-days to 0 (confidence interval [CI], -1.1 to 18.3); on general surgery the rate was constant at 7 infections per 1000 device-days (CI, -12.1 to 10.8).
  
  
  CONCLUSIONS
  Audit and feedback of aggregated patient-level urinary catheter duration determined from electronic documentation may prove effective in improving urinary catheter management for surgical patients.
authors.affiliation: Division of Health Care Policy Research, University of Colorado Denver, School of Medicine, Denver, Colorado, USA. Heidi.Wald@ucdenver.edu
authors.forename: Heidi L
authors.initials: HL
authors.lastname: Wald
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Kramer
mesh_terms: D000328:Adult; D000368:Aged; D005240:Feasibility Studies; D005246:Feedback; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000379:methods / Q000592:standards*; D008875:Middle Aged; D024802:Nurse's Role; D011182:Postoperative Care / Q000379:methods / Q000592:standards*; D012307:Risk Factors; D013997:Time Factors; D014546:Urinary Catheterization / Q000009:adverse effects*; D014552:Urinary Tract Infections / Q000209:etiology / Q000517:prevention & control*