Urinary catheters in the emergency department: Very elderly women are at high risk for unnecessary utilization

Background: Many of the urinary catheters (UCs) placed in the emergency department (ED) might not be necessary. We evaluated compliance with our institutional UC utilization guidelines and assessed factors influencing utilization. Methods: We conducted a 12-week retrospective observational study evaluating UC utilization in all admissions from the ED. Data included reason for placement, presence of a physician's order for placement, resident physician involvement, and patient age and sex. Results: Out of 4521 patients evaluated, 532 (11.8%) had a UC placed. Of these UCs, 371 (69.7%) were indicated, and 312 (58.6%) had a physician's order documented. The mean age of the patients who had a UC placed without an indication was 71.3 +/- 18.8 years, that of patients with an indication was 60.0 +/- 22.4 years (P < .0001), and that of patients who did not have a UC placed was 56.2 +/- 22.6 years (P < .0001). Half of the women aged >= 80 years who had a UC placed did not have an indication according to our institutional guidelines. Multivariate logistic regression showed that women were 1.9 times more likely than men, and those age >= 80 years were 2.9 times more likely than those age <= 50 years, to have a UC placed without an indication. Conclusion: Very elderly women are at high risk for inappropriate UC utilization in the ED. Interventions are needed to address this vulnerable population.