Using Agile Science to implement alternatives to indwelling urinary catheters

Alternatives to indwelling urinary catheters can reduce catheter-associated urinary tract infections (CAUTIs), but adoption is often inconsistent. We used an Agile Science framework to implement external urinary devices across a large hospital network.

Using an Agile Implementation process, a multidisciplinary team co-designed iterative "sprints" targeting electronic medical record changes, standardized auditing, education, and workflow integration. Process measures included learning-module completion and audit compliance. Outcome measures were CAUTI Standardized Infection Ratio (SIR) and indwelling catheter Standardized Utilization Ratio (SUR).

An initial daily auditing plan proved infeasible, leading to risk-based audits that achieved 99% to 100% compliance. Completion of a learning module, introduced in quarter 1 (Q1) 2024, increased from 34% (February 2024) to 99% by Q3 2025. Network CAUTI SIR decreased to 0.52 by Q3 2025, a 36% reduction from the pre-intervention period (Q4 2023). The network SUR has been sustained below the 2023 National Healthcare Safety Network (NHSN) national median.

Agile Implementation's emphasis on iteration and feedback proved critical for adapting interventions to ensure their success and sustainability.

Agile Implementation enabled rapid adoption and optimization of indwelling urinary catheter alternatives, associated with reductions in CAUTI SIR.