title: Provider perspectives on the use of indwelling urinary catheters in older adults in emergency department settings: developing a novel clinical protocol.
abstract: BACKGROUND
  Indwelling urinary catheters (IUCs) are commonly placed in older adult (aged ≥ 65 years) patients in emergency department (ED) settings, often for inappropriate indications. The aim of our qualitative study was to explore ED provider knowledge, attitudes, and practice patterns surrounding use of IUCs in older adult patients in the ED setting, to better guide development of a clinical protocol.
  
  
  METHODS
  We conducted 4 focus groups with 38 participants at a large academic medical center. Each focus group was conducted with a single ED provider type: attending physicians, residents, physician assistants, or nurses. Focus groups used a semistructured format, ranging in duration from 23-33 minutes. The sessions were audiorecorded, fully transcribed, and data were coded and analyzed to identify themes.
  
  
  RESULTS
  Participants reported believing that IUCs are overutilized in ED settings, confirming that IUCs are infrequently removed once placed and often inserted for staff convenience. Participants reported that current clinical decision making about IUC placement varies widely; yet all acknowledged the known risks for patient safety and willingness to adopt a clinical protocol to standardize practice. Focus groups were a critical component for the development of a user-friendly protocol, identifying 10 key elements for successful implementation and 11 potential barriers.
  
  
  CONCLUSIONS
  An evidence-based clinical protocol guiding ED providers in appropriate placement and management of IUCs in older adults would be welcomed.
authors: Department of Medicine, Division of Emergency Medicine, Weill Cornell Medical College, New York, NY. Electronic address: mrm9006@med.cornell.edu.
authors: Mary R
authors: MR
authors: Mulcare
authors: Department of Medicine, Division of Emergency Medicine, Weill Cornell Medical College, New York, NY.
authors: Tony
authors: T
authors: Rosen
authors: Department of Medicine, Division of Emergency Medicine, Weill Cornell Medical College, New York, NY.
authors: Sunday
authors: S
authors: Clark
authors: Department of Medicine, Division of Emergency Medicine, Weill Cornell Medical College, New York, NY.
authors: Benjamin A
authors: BA
authors: Scherban
authors: Department of Medicine, Division of Emergency Medicine, Weill Cornell Medical College, New York, NY.
authors: Michael E
authors: ME
authors: Stern
authors: Department of Medicine, Division of Emergency Medicine, Weill Cornell Medical College, New York, NY.
authors: Neal E
authors: NE
authors: Flomenbaum
mesh_terms: D000368:Aged; D002408:Catheters, Indwelling / Q000592:standards*; D002985:Clinical Protocols / Q000592:standards*; D004636:Emergency Service, Hospital / Q000592:standards*; D055416:Evidence-Based Emergency Medicine; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016014:Linear Models; D008505:Medical Staff, Hospital; D009726:Nurses; D061214:Patient Safety / Q000592:standards; D010823:Physician Assistants; D036301:Qualitative Research; D014546:Urinary Catheterization / Q000592:standards; D062885:Urinary Catheters / Q000382:microbiology*
keywords: Catheter-associated urinary tract infections; Clinical protocol; Hospital acquired infections; Patient safety