• Mohamad G Fakih, Margarita E Pena, Stephen Shemes, Janice Rey, Dorine Berriel-Cass, Susan M Szpunar, Ruth T Savoy-Moore, and Louis D Saravolatz.
• Division of Infectious Diseases, Department of Medicine, St. John Hospital and Medical Center and Wayne State University School of Medicine, Detroit, MI, USA. mohamad.fakih@stjohn.org
• Acad Emerg Med. 2010 Mar 1;17(3):337-40.

ObjectivesAvoiding placement of unnecessary urinary catheters (UCs) in the emergency department (ED) affects UC utilization during hospitalization. The authors sought to evaluate the effect of establishing institutional guidelines for appropriate UC placement coupled with emergency physician (EP) education on UC utilization.MethodsUrinary catheter utilization was measured before and after the establishment of guidelines and EP education. Data collected included the presence of a UC on ED arrival, placement of a UC in the ED, documentation of a physician order for UC placement, reasons for placement, and compliance with the guidelines. Chi-square analyses were used to study the association between pre- and postintervention time periods and catheter use.ResultsA total of 377 (15%) patients had UCs; only 151 (47%) UCs initially placed in the ED had a physician order documented. UC placement was appropriately indicated in 75.5% of patients with a documented physician order, but in only 52% of cases without a documented physician order (p<0.001). The physician intervention was associated with an overall reduction in UC utilization from 16.4% to 13% (p=0.018). Physicians ordered 40% fewer UCs postintervention compared to preintervention. Preintervention, a physician order for UC placement was found indicated in 72.6% patients, compared to 82.2% patients with UC placed postintervention (p=0.21).ConclusionsEstablishing guidelines for UC placement and physician education in the ED were associated with a marked reduction in utilization. However, addressing appropriate UC utilization may require evaluating other factors such as nursing influence on utilization.Copyright (c) 2010 by the Society for Academic Emergency Medicine.

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