Emergency room staff education and use of a urinary catheter indication sheet improves appropriate use of foley catheters.

BACKGROUND: Inappropriate use of indwelling urinary tract catheters (IUTCs) in the hospital setting is widespread and associated with nosocomial urinary tract infections. In a prior observational study, we found less than half of IUTCs placed in hospitalized elderly patients had appropriate indications. We tested an emergency department (ED) intervention to increase appropriate use of IUTCs.

METHODS: The intervention included ED staff education and an indication checklist attached to each catheter kit for staff to complete prior to use. We completed a chart audit on appropriate use of urinary catheters in 100 consecutive catheterized ED patients and tracked catheter billing data before and after the intervention.

RESULTS: Appropriate use of catheters increased from 37% to 51% (P=0.06). The presence of a physician order for catheter placement significantly increased from 43% to 63% (P< 0.01). There was a large and sustained decrease in the total number of catheters placed in the ED after the intervention (N=2029 in 2001 and N=2188 in 2002 to N=300 in 2004 and N= 512 in 2005).

CONCLUSIONS: Education and use of an indication sheet produced a dramatic reduction in total number of catheters used and had a smaller impact on appropriateness of use and documentation.