Special article
Are physicians aware of which of their patients have indwelling urinary catheters?

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Abstract

PURPOSE: Although infections associated with indwelling urinary catheters are common, costly, and morbid, the use of these catheters is unnecessary in more than one-third of patients. We sought to assess whether attending physicians, medical residents, and medical students are aware if their hospitalized patients have an indwelling urinary catheter, and whether physician awareness is associated with appropriate use of these catheters.

METHODS: The physicians and medical students responsible for patients admitted to the medical services at four university-affiliated hospitals were given a list of the patients on their service. For each patient, the provider was asked: “As of yesterday afternoon, did this patient have an indwelling urethral catheter?” Respondents’ answers were compared with the results of examining the patient.

RESULTS: Among 288 physicians and students on 56 medical teams, 256 (89%) completed the survey. Of 469 patients, 117 (25%) had an indwelling catheter. There were a total of 319 provider-patient observations among these 117 patients. Overall, providers were unaware of catheterization for 88 (28%) of the 319 provider-patient observations. Unawareness rates by level of training were 21% for students, 22% for interns, 27% for residents, and 38% for attending physicians (P = 0.06). Catheter use was inappropriate in 36 (31%) of the 117 patients with a catheter. Providers were unaware of catheter use for 44 (41%) of the 108 provider-patient observations of patients who were inappropriately catheterized. Catheterization was more likely to be appropriate if respondents were aware of the catheter (odds ratio = 3.7; 95% confidence interval, 2.1 to 6.7, P <0.001).

CONCLUSION: Physicians are commonly unaware that their patients have an indwelling urinary catheter. Inappropriate catheters are more often “forgotten” than appropriate ones. System-wide interventions aimed at discontinuing unnecessary catheterization seem warranted.

Section snippets

Study sample and design

The physicians (ie, attending physician and resident) and medical students responsible for patients admitted to the general medicine wards at four university-affiliated medical centers (three Veterans Affairs medical centers and one university hospital) were the subjects of the study. All sites were in the United States; two were in the Midwest, one in California, and one in the Pacific Northwest. All sites were actively involved in internal medicine residency training and medical school

Results

A total of 56 medical teams were surveyed at the four sites. Each team usually consisted of one attending physician, one or two residents, one or two interns, and up to four medical students. On average, there were 9 patients per team (range, 4 to 17). Of 288 possible respondents, 256 (89%) completed the survey, including 76 of 82 medical students, 72 of 83 interns, 59 of 67 residents, and 49 of 56 attending physicians.

Discussion

The results of this survey demonstrate that physicians and medical students were often unaware that their inpatients had an indwelling urinary catheter. This survey also confirmed previous studies showing that indwelling urinary catheters are often used inappropriately 14, 15. An important new finding is that these inappropriately used catheters were much more often “forgotten” than the appropriate ones.

We also found that as the provider’s training level increased, his or her awareness of a

Acknowledgements

We are indebted to the medical students, housestaff, and faculty who participated in this evaluation; to Rodney Hayward, MD, Carol Chenoweth, MD, Peter Jensen, MD, and Carol Kauffman, MD, for guidance; and to Veronica McCarthy for data entry.

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