title: Avoiding potential harm by improving appropriateness of urinary catheter use in 18 emergency departments.
abstract: OBJECTIVE
  Urinary catheters are often placed in the emergency department (ED) and are associated with an increased safety risk for hospitalized patients. We evaluate the effect of an intervention to reduce unnecessary placement of urinary catheters in the ED.
  
  
  METHODS
  Eighteen EDs from 1 health system underwent the intervention and established institutional guidelines for urinary catheter placement, provided education, and identified physician and nurse champions to lead the work. The project included baseline (7 days), implementation (14 days), and postimplementation (6 months, data sampled 1 day per month). Changes in urinary catheter use, indications for use, and presence of physician order were evaluated, comparing the 3 periods.
  
  
  RESULTS
  Sampled patients (13,215) admitted through the ED were evaluated, with 891 (6.7%; 95% confidence interval [CI] 6.3% to 7.2%) having a catheter placed. Newly placed catheters decreased from 309 of 3,381 (9.1%) baseline compared with 424 of 6,896 (6.1%) implementation (Δ 3.0%; 95% CI 1.9% to 4.1%), and 158 of 2,938 (5.4%) postimplementation periods (Δ 3.8%; 95% CI 2.5% to 5.0%). The appropriateness of newly placed urinary catheters improved from baseline (228/308; 74%) compared with implementation (385/421; 91.4%; Δ 17.4%; 95% CI 11.9% to 23.1%) and postimplementation periods (145/158; 91.8%; Δ 23.9%; 95% CI 18% to 29.3%). Physician order documentation in the presence of the urinary catheter was 785 of 889 (88.3%), with no visible change over time. Improvements were noted for different-size hospitals and were more pronounced for hospitals with higher urinary catheter placement baseline.
  
  
  CONCLUSIONS
  The implementation of institutional guidelines for urinary catheter placement in the ED, coupled with the support of clearly identified physician and nurse champions, is associated with a reduction in unnecessary urinary catheter placement. The effort has a substantial potential of reducing patient harm hospital-wide.
authors.affiliation: Department of Infection Prevention and Control, St John Hospital and Medical Center, Detroit, MI; Wayne State University School of Medicine, Detroit, MI. Electronic address: mohamad.fakih@stjohn.org.
authors.forename: Mohamad G
authors.initials: MG
authors.lastname: Fakih
authors.affiliation: Clinical Excellence, Ascension Health, St. Louis, MO.
authors.forename: Michelle
authors.initials: M
authors.lastname: Heavens
authors.affiliation: Clinical Excellence, Ascension Health, St. Louis, MO.
authors.forename: Julie
authors.initials: J
authors.lastname: Grotemeyer
authors.affiliation: Department of Medical Education, St John Hospital and Medical Center, Detroit, MI.
authors.forename: Susanna M
authors.initials: SM
authors.lastname: Szpunar
authors.affiliation: Clinical Excellence, Ascension Health, St. Louis, MO.
authors.forename: Clariecia
authors.initials: C
authors.lastname: Groves
authors.affiliation: Clinical Excellence, Ascension Health, St. Louis, MO.
authors.forename: Ann
authors.initials: A
authors.lastname: Hendrich
mesh_terms: D004502:Education, Medical, Continuing; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D058996:Quality Improvement / Q000458:organization & administration / Q000706:statistics & numerical data; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*; D014546:Urinary Catheterization / Q000009:adverse effects / Q000706:statistics & numerical data*