• Mary R Mulcare, Tony Rosen, Sunday Clark, Benjamin A Scherban, Michael E Stern, and Neal E Flomenbaum.
• Department of Medicine, Division of Emergency Medicine, Weill Cornell Medical College, New York, NY. Electronic address: mrm9006@med.cornell.edu.
• Am J Infect Control. 2015 Apr 1;43(4):341-7.

BackgroundIndwelling urinary catheters (IUCs) are commonly placed in older adult (aged ≥ 65 years) patients in emergency department (ED) settings, often for inappropriate indications. The aim of our qualitative study was to explore ED provider knowledge, attitudes, and practice patterns surrounding use of IUCs in older adult patients in the ED setting, to better guide development of a clinical protocol.MethodsWe conducted 4 focus groups with 38 participants at a large academic medical center. Each focus group was conducted with a single ED provider type: attending physicians, residents, physician assistants, or nurses. Focus groups used a semistructured format, ranging in duration from 23-33 minutes. The sessions were audiorecorded, fully transcribed, and data were coded and analyzed to identify themes.ResultsParticipants reported believing that IUCs are overutilized in ED settings, confirming that IUCs are infrequently removed once placed and often inserted for staff convenience. Participants reported that current clinical decision making about IUC placement varies widely; yet all acknowledged the known risks for patient safety and willingness to adopt a clinical protocol to standardize practice. Focus groups were a critical component for the development of a user-friendly protocol, identifying 10 key elements for successful implementation and 11 potential barriers.ConclusionsAn evidence-based clinical protocol guiding ED providers in appropriate placement and management of IUCs in older adults would be welcomed.Copyright © 2015 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

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