From the 2022 HVPA National Conference
Harry Flaster MD (Johns Hopkins Hospital Emergency Department), Kristin Ridenour MPH
Complications related to chronic, indwelling urinary catheters and complications involving the placement of new urinary catheters are frequently encountered clinical scenarios in the emergency department (ED). They also represent a frequently overlooked contribution to patient morbidity and urology consultation.
To reduce complications related to urinary catheters, to reduce unnecessary urologic consultations, and to improve the emergency department’s ability to independently manage common urinary catheter related clinical scenarios, we designed and implemented an evidence-based guideline for urinary catheter management. Our target audience is nurses, advanced practitioners, residents, fellows and attendings.
We first performed a needs assessment survey to determine resident comfort with tubes, lines, and drains, including urinary catheters, that are encountered or implemented in the ED. We then reviewed the current literature, identifying best practices and high-yield existing resources for urinary catheter guidelines. Next, we created a draft urinary catheter guideline, which we then shared with our urology colleagues for review. After urology input, our guideline was shared with our department over email, announced during our weekly conference, and published within our EMR framework for clinical use. Finally, the use of the guideline was monitored, and a follow-up survey sent to residents.
In the first month after implementation, the guideline was used 6 times. Over the next five months, it was used an average of 1.33 times a month for a total of 14 times. A survey was sent to all residents two months after implementation to determine its perceived utility. Of the 16 residents who responded, only 2 had used the guideline.
Utilization of the guideline to-date has been mixed, although it appears that is because many residents were unaware of the existence of the new guideline. Iterative work remains to improve knowledge of the guideline, utilization, and utility of the guideline itself. Further study is planned to ascertain any effect on the number of urology consults made after guideline implementation.
The implementation of this guideline provided a new resource for a common clinical scenario seen in the emergency department. The guideline remains a work in progress. Additional goals include: 1) increase utilization of the guideline, 2) determine if the number of urology consultations for urinary catheter related issues have decreased since implementation, and 3) track patient centered metrics such as the number of “single pass” urinary catheter attempts.