ClinicalReducing Indwelling Urinary Catheter Use in the Emergency Department: A Successful Quality-Improvement Initiative☆
Section snippets
Methods
A multidisciplinary strategy was used to examine ED practice related to IUC utilization and determine best-practice interventions. The entire project lasted more than 1 year (Figure 1).
Results
The intervention was associated with a 2.49% absolute reduction of catheterizations in admitted patients (95% confidence interval, 2.46%-2.52%), which represents a 33% relative decrease in the proportion of patients admitted to inpatient status with IUCs placed in the emergency department (9.05% ± 0.49% before intervention vs 6.1% ± 1.1% after intervention). These results appeared to be partially attenuated over the 6 months of follow-up (Figure 4).
A 9-item survey to understand the impact of
Discussion
This QI project made major strides in changing the ED culture regarding IUC insertion. We found that the use of focus groups was a key strategy to the success of this project because the participants provided a deeper understanding of the decision making behind placing an IUC. Our interventions were then targeted to the specific needs of our emergency department. By use of multiple approaches of dissemination, providers were introduced to the concept of using urinary management alternatives in
Conclusion
The insertion of IUCs in the ED setting is a common occurrence in the patient facing hospital admission, and the clinical appropriateness for initial insertion is often unjustified. Delayed complications such as CAUTIs are often underappreciated by the ED personnel, perhaps contributing to a “minor procedure” status without perceived morbidity and mortality. Our interdisciplinary team was able to define the problem of inappropriate IUC insertion in our institution, create an educational tool
Robin A. Scott, Member, Colorado Chapter, is Clinical Nurse Specialist, University of Colorado Hospital, Aurora, CO.
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Cited by (0)
Robin A. Scott, Member, Colorado Chapter, is Clinical Nurse Specialist, University of Colorado Hospital, Aurora, CO.
Kathleen S. Oman, Member, Colorado Chapter, is Research Nurse Scientist, University of Colorado Hospital, and Associate Professor, College of Nursing, University of Colorado Denver, Aurora, CO.
MaryBeth Flynn Makic is Research Nurse Scientist, University of Colorado Hospital, and Associate Professor, College of Nursing, University of Colorado Denver, Aurora, CO.
Regina M. Fink is Research Nurse Scientist, University of Colorado Hospital, Aurora, CO.
Teri M. Hulett is Infection Preventionist, University of Colorado Hospital, Aurora, CO.
Jane S. Braaten is PhD Student, College of Nursing, University of Colorado Denver, Aurora, CO.
Fred Severyn is Associate Professor, School of Medicine, University of Colorado Denver, Aurora, CO.
Heidi L. Wald is Assistant Professor, School of Medicine, University of Colorado Denver, Aurora, CO.
Earn Up to 9.5 CE Hours. See page 293.
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This project was funded by a University of Colorado Hospital/School of Medicine QI (Quality-Improvement) Small Grant.