Reducing Intermittent Catheterization in Cases of Postvoid Residual Urine Without Increasing Hospital-Acquired...

Area of Science:

• Geriatric Medicine
• Urology
• Quality Improvement in Healthcare

Background:

• Postvoid residual (PVR) urine is prevalent in older adults, often managed with intermittent catheterization due to perceived UTI risk.
• The association between PVR urine and increased UTI risk is uncertain, while intermittent catheterization itself carries a clear risk of UTI.
• Evidence suggests higher thresholds for intermittent catheterization are safe for patients awaiting spontaneous urination post-surgery.

Purpose of the Study:

• To decrease bladder scans and intermittent catheterizations for geriatric patients with PVR urine or awaiting spontaneous urination.
• To implement this reduction without increasing hospital-acquired urinary tract infections (HAUTIs).

Main Methods:

• A quality improvement project utilizing the Model for Improvement framework on two geriatric units.
• Workflow analysis and driver diagram development to guide process changes.
• Three Plan-Do-Study-Act cycles to create and implement a guideline for intermittent catheterization in PVR urine cases.

Main Results:

• Median weekly bladder scans reduced by 32.2% (146 to 99).
• Median weekly intermittent catheterizations decreased by 35.4% (41 to 26.5).
• Hospital-acquired urinary tract infection (HAUTI) incidence remained stable, showing only random variation and similar rates to previous years.

Conclusions:

• Implementing a guideline for intermittent catheterization in patients with PVR urine can effectively reduce procedures.
• This guideline achieves procedural reduction without a concurrent increase in HAUTIs.
• The findings support optimizing PVR urine management in geriatric populations.