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Urinary Retention Evaluation and Catheterization Algorithm for Adult Inpatients.
Kristin Chrouser1,2, Karen E Fowler2, Jason D Mann3
1Department of Urology, University of Michigan, Ann Arbor.
JAMA Network Open
|July 16, 2024
Summary
A new algorithm helps manage acute urinary retention (UR) in hospitalized adults. It guides appropriate use of bladder scanners and catheterization, improving patient safety and care.
Area of Science:
- Urology
- Healthcare Management
- Clinical Informatics
Background:
- Acute urinary retention (UR) is a common clinical issue.
- Variations in diagnosis and management of UR can lead to patient harm.
- There is a need for standardized protocols for UR management in hospitals.
Purpose of the Study:
- To develop a clinical algorithm for the screening and management of acute urinary retention (UR) in adult inpatients.
- To standardize the diagnostic and therapeutic approaches to UR.
- To improve patient safety and reduce harm associated with UR management.
Main Methods:
- A mixed-methods approach was employed, combining the RAND/UCLA Appropriateness Method with qualitative interviews.
- An 11-member multidisciplinary expert panel developed an initial algorithm based on 107 clinical scenarios.
- Thirty-three frontline clinicians provided feedback on the draft algorithm through semistructured interviews to inform refinements.
Main Results:
- The developed algorithm prioritizes bladder scanners over immediate catheterization for UR diagnosis.
- Specific bladder scanner volume thresholds (≥300 mL symptomatic, ≥500 mL asymptomatic) were established for prompting catheterization.
- Intermittent catheterization is preferred over indwelling catheterization for lower bladder volumes.
- Frontline clinicians found the evidence-based protocol needed, emphasizing simplicity, graphical appeal, and EMR integration.
Conclusions:
- A systematic, multidisciplinary approach yielded a UR evaluation and catheterization algorithm.
- The algorithm aims to enhance patient safety by optimizing the use of bladder scanners and catheterization.
- This evidence- and expert opinion-based tool provides practical guidance for managing adult UR in inpatient settings.
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