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

Area of Science:

• Healthcare Management
• Infectious Disease Prevention
• Patient Safety

Background:

• Urinary catheters are frequently used in emergency departments (EDs) but are often unnecessary and linked to complications.
• Previous interventions to reduce ED urinary catheter use have not compared different organizational contexts.

Purpose of the Study:

• To compare the effectiveness of system-based versus state-based interventions aimed at reducing urinary catheter use in the ED.
• To evaluate the impact of these interventions on appropriate catheter use and the presence of physician orders.

Main Methods:

• 18 system-based hospitals and 16 state-based hospitals implemented ED interventions to decrease urinary catheter use.
• Data collected included catheter placement, indications, and physician orders.
• Multilevel negative binomial regression analyzed system-based versus state-based intervention outcomes.

Main Results:

• The system-based intervention demonstrated statistically significant reductions in urinary catheter placement (IRR, 0.79; P=.02).
• Appropriate urinary catheter use significantly improved in the system-based intervention (OR, 1.86; P=.004).
• No significant difference was found in the presence of physician orders between the collaborative structures (OR, 1.14; P=.60).

Conclusions:

• A system-based ED intervention, incorporating institutional guidelines and clinical champions, effectively reduced unnecessary urinary catheter use.
• This collaborative structure was associated with improved appropriate urinary catheter utilization.
• The findings highlight the importance of organizational context in the success of clinical interventions.