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Reducing Inappropriate Urinary Catheter Use in the Emergency Department: Comparing Two Collaborative Structures
- Source :
- Infection Control & Hospital Epidemiology. 39:77-84
- Publication Year :
- 2017
- Publisher :
- Cambridge University Press (CUP), 2017.
-
Abstract
- BACKGROUNDUrinary catheters, many of which are placed in the emergency department (ED) setting, are often inappropriate, and they are associated with infectious and noninfectious complications. Although several studies evaluating the effect of interventions have focused on reducing catheter use in the ED setting, the organizational contexts within which these interventions were implemented have not been compared.METHODSA total of 18 hospitals in the Ascension health system (ie, system-based hospitals) and 16 hospitals in the state of Michigan (ie, state-based hospitals led by the Michigan Health and Hospital Association) implemented ED interventions focused on reducing urinary catheter use. Data on urinary catheter placement in the ED, indications for catheter use, and presence of physician order for catheter placement were collected for interventions in both hospital types. Multilevel negative binomial regression was used to compare the system-based versus state-based interventions.RESULTSA total of 13,215 patients (889 with catheters) from the system-based intervention were compared to 12,104 patients (718 with catheters) from the state-based intervention. Statistically significant and sustainable reductions in urinary catheter placement (incidence rate ratio, 0.79;P=.02) and improvements in appropriate use of urinary catheters (odds ratio [OR], 1.86;P=.004) in the ED were observed in the system-based intervention, compared to the state-based intervention. Differences by collaborative structure in changes in presence of physician order for urinary catheter placement (OR, 1.14;P=.60) were not observed.CONCLUSIONSAn ED intervention consisting of establishing institutional guidelines for appropriate catheter placement and identifying clinical champions to promote adherence was associated with reducing unnecessary urinary catheter use under a system-based collaborative structure.Infect Control Hosp Epidemiol2018;39:77–84
- Subjects :
- Microbiology (medical)
Program evaluation
Michigan
medicine.medical_specialty
Epidemiology
Urinary system
Psychological intervention
Medical Overuse
Urinary Catheters
Rate ratio
Article
03 medical and health sciences
Catheters, Indwelling
0302 clinical medicine
Intervention (counseling)
medicine
Humans
030212 general & internal medicine
Cross Infection
business.industry
030208 emergency & critical care medicine
Odds ratio
Emergency department
Catheter
Infectious Diseases
Catheter-Related Infections
Emergency medicine
Regression Analysis
Emergency Service, Hospital
Urinary Catheterization
business
Program Evaluation
Subjects
Details
- ISSN :
- 15596834 and 0899823X
- Volume :
- 39
- Database :
- OpenAIRE
- Journal :
- Infection Control & Hospital Epidemiology
- Accession number :
- edsair.doi.dedup.....331ed602c66dcd5f73daec10b95906b0