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Reducing Inappropriate Urinary Catheter Use in the Emergency Department: Comparing Two Collaborative Structures

Published online by Cambridge University Press:  18 December 2017

M. Todd Greene ,
Mohamad G. Fakih ,
Sam R. Watson ,
David Ratz  and
Sanjay Saint
M. Todd Greene*
Affiliation:
Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan
Mohamad G. Fakih
Affiliation:
Care Excellence, Ascension, St Louis, Missouri
Sam R. Watson
Affiliation:
Michigan Health and Hospital Association, Okemos, Michigan
David Ratz
Affiliation:
Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan
Sanjay Saint
Affiliation:
Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan Veterans Affairs/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan
*
Address correspondence to M. Todd Greene, PhD, MPH, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Department of Internal Medicine, Michigan Medicine, 2800 Plymouth Rd, NCRC Bldg 16, Room 470C, Ann Arbor, MI 48109 (mtgreene@med.umich.edu).
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Abstract

BACKGROUND

Urinary catheters, many of which are placed in the emergency department (ED) setting, are often inappropriate, and they are associated with infectious and noninfectious complications. Although several studies evaluating the effect of interventions have focused on reducing catheter use in the ED setting, the organizational contexts within which these interventions were implemented have not been compared.

METHODS

A total of 18 hospitals in the Ascension health system (ie, system-based hospitals) and 16 hospitals in the state of Michigan (ie, state-based hospitals led by the Michigan Health and Hospital Association) implemented ED interventions focused on reducing urinary catheter use. Data on urinary catheter placement in the ED, indications for catheter use, and presence of physician order for catheter placement were collected for interventions in both hospital types. Multilevel negative binomial regression was used to compare the system-based versus state-based interventions.

RESULTS

A total of 13,215 patients (889 with catheters) from the system-based intervention were compared to 12,104 patients (718 with catheters) from the state-based intervention. Statistically significant and sustainable reductions in urinary catheter placement (incidence rate ratio, 0.79; P=.02) and improvements in appropriate use of urinary catheters (odds ratio [OR], 1.86; P=.004) in the ED were observed in the system-based intervention, compared to the state-based intervention. Differences by collaborative structure in changes in presence of physician order for urinary catheter placement (OR, 1.14; P=.60) were not observed.

CONCLUSIONS

An ED intervention consisting of establishing institutional guidelines for appropriate catheter placement and identifying clinical champions to promote adherence was associated with reducing unnecessary urinary catheter use under a system-based collaborative structure.

Infect Control Hosp Epidemiol 2018;39:77–84

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 1 , January 2018 , pp. 77 - 84
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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