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Updated: Mar 2, 2026
An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection
Published on: June 24, 2025
Urinary catheter-related visits to the emergency department and implications for community services
Tiziana Ansell1, Danielle Harari2
1Clinical Nurse Specialist Bladder & Bowel Dysfunction, Health Innovation Network.
Insights
Patients with urinary catheters frequently visit the emergency department (ED) for complications like infections and urosepsis. Improved community care is needed to manage these complex patient needs outside the hospital setting.
Area of Science:
- Urology
- Healthcare Management
- Public Health
Background:
- Long-term urinary catheter use is associated with significant patient complications.
- Fragmented community healthcare services contribute to emergency department (ED) attendances for catheter-related issues.
Purpose of the Study:
- To review catheterised patients attending a London hospital's ED.
- To determine the incidence, reasons for attendance, and costs associated with these visits.
- To inform future planning for out-of-hospital care for catheterised patients.
Main Methods:
- A catheter collaborative developed survey questions.
- Retrospective review and descriptive statistical analysis of one month of clinical records.
- Patient identification via electronic records using the 'urological complaint' code.
Main Results:
- 41% of urological complaints in the ED were catheter-related.
- Catheter complications led to ED stays averaging 4.8 hours, with 38% occurring during out-of-hours periods.
- 34% of patients had catheter-related infections, including bladder infections and sepsis, requiring antibiotic treatment.
Conclusions:
- Catheterised patients present complex needs, with high rates of urinary infections and sepsis admissions.
- Attendance is driven by complex medical histories (neurological conditions, disability) rather than age.
- Enhanced community services, including diagnostics and IV treatment access, are crucial for managing these patients effectively.
Abstract:
Thousands of patients live with urinary catheters and the potential complications deriving from long-term use. Disjointed community services may result in patients attending the emergency department (ED) to manage catheter complications.
Aim:
to conduct a service review of catheterised patients attending the ED of a large London hospital; to describe incidence, reasons for attendance and cost to inform future planning for out-of-hospital care.
Method:
a catheter collaborative, consisting of multidisciplinary health professionals and patients, formulated survey questions. Patients were identified from the electronic patient record by searching for the code 'urological complaint'. One month of clinical records were retrospectively reviewed and analysed using descriptive statistics.
Results:
287 patients attended the department with urological complaints: 41 (14%) had urinary catheter problems, of these 24 (59%) patients were discharged and 17 (41%) were admitted for further treatment. Stays in ED varied from 1 hour 13 minutes to 17 hours (mean = 4.8 hours). A total of 9 patients (38%) were sent home during antisocial hours (9 pm to 7 am), 4 patients were discharged between midnight and 2 am. Patients admitted had mean stays of 4.11 days. Most admissions were short term for intravenous (IV) treatments; 3 patients were hospitalised for 20 days. A total of 14 patients (34%) were diagnosed with catheter-related infections: 11 (79%) had bladder infections and 3 (21%) had septicaemia. All 14 patients (100%) had urine-culture-confirmed infections, mainly from coliform, proteus and pseudomonas species. A total of 20 patients (49%) received antibiotic treatment. The majority of patients received an initial IV dose followed, where required, by oral treatment on discharge.
Conclusions:
many catheterised patients had complex needs with high rates of urinary infections and admissions for urosepsis. High attendance related less to old age but more to complexity of history, such as neurological conditions and disability. Only a proportion of these patients could be safely treated by district nurse teams. A significant proportion would require more responsive community services with several spells of short-term input (e.g. daily or more than once-daily visits) and access to diagnostics, microbiology, pharmaceutical input and IV treatments.
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