title: Impact of the lack of community urinary catheter care services on the Emergency Department.
abstract: To conduct an audit of patients presenting with long-term urinary catheter (LTC)-associated problems to our Emergency Department (ED) and to assess the availability of community nursing support for their LTC. We also estimated the cost implication to the health service and the potential solutions to this issue, as although catheter care is provided by community nurses, LTC problems are common presentations to the ED and are often significant burdens to the services.
  
  
  
  A study was carried out of all patients presenting to the ED with a urinary catheter problem, specifically studying LTCs and the reason for presentation, district nurses' involvement, and the intervention received.
  
  
  
  In all, 78 patients with a urinary catheter problem presented to the ED over a 69-day period, of whom 59 (68%) had a LTC. In all, 33 patients (42%) attended during normal working hours between 0900 and 1700 h. The mean (range) age was 74 (42-93) years and the duration the LTC had been in situ was 11 (1-120) months. The most common reasons for attendance were blocked catheter (37 patients, 47%) and catheter-bypass (18, 23%). Only 28 patients (36%) were known to district nursing services, and 14% were referred by a district nurse. Most of the remaining patients self-referred to the ED. No patient had any documented contact with their general practitioner. In addition, 64 patients (82%) had their catheter issues addressed adequately by ED nurses or doctors, without any urology involvement.
  
  
  
  The high morbidity of LTCs causes a considerable demand on ED services, and has heavy cost implications to the health system. Most patients had minimal community nurse support, and their catheter problems were easily dealt with by ED nurses and doctors.
authors.affiliation: Department of Urology, King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Li June
authors.initials: LJ
authors.lastname: Tay
authors.affiliation: Department of Urology, King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Lyons
authors.affiliation: Department of Urology, King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Irene
authors.initials: I
authors.lastname: Karrouze
authors.affiliation: Department of Urology, King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Taylor
authors.affiliation: Department of Urology, King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Azhar A
authors.initials: AA
authors.lastname: Khan
authors.affiliation: Department of Urology, King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Thompson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000600:supply & distribution*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D014546:Urinary Catheterization / Q000706:statistics & numerical data*
keywords: Emergency Department; catheter blockage; cost implications; district nurse; long-term urinary catheter