We initiated as a quality improvement project in two New York City hospitals, a comparison of nurse-initiated with physician-initiated daily verbal reminders to remove unnecessary urinary catheters.
Methods: At two hospitals in New York City from May 1 to June 6, 2014, inpatients on the medical service (excluding ICUs) who had an indwelling urinary catheter were identified daily and alternately assigned to an MD or nurse intervention group. Patients who had documentation of appropriate indications for catheter use were excluded. An MD or infection control nurse would contact the medical team and question the need for continued catheter use daily until the catheter was removed or hospitalization ended. Additional patients for whom no care provider was contacted formed the control group. For the intervention groups, days of catheter use after intervention (in days) and for controls total duration minus the average time between catheter insertion and intervention in the other groups were compared.
Results: 22 patients were assigned to the MD group, 21 to the RN group, and 11 to the control group. Sixty-nine percent of patients were female and 81% were >64 years old. There were no differences in demographics between groups. Post-intervention catheter mean (+SD) duration in the MD group was 0.545 + 0.80 days compared to controls at 2.67 + 3.23 days (P=0.0027) and to the RN group at 1.67 + 2.74 days (P=0.03). There was a trend towards a decrease in post-intervention catheter days comparing the RN group to control which did not reach statistical significance (P=0.12).
Conclusion: Daily verbal reminders are a useful adjunct in reducing unnecessary urinary catheter use. This study showed the duration of catheter use was significantly decreased if an MD performed the reminder compared to an infection control nurse. Further studies are needed to determine the cost-effectiveness of this approach to preventing CAUTIs.
E. Santos, None
A. Gabasan, None
O. Dzenkevych, None
I. Kourouni, None
R. Klein, None