A Reminder Reduces Urinary Catheterization in Hospitalized Patients

Background: Indwelling urinary catheters are placed in up to 25% of hospitalized patients and are a leading cause of hospital-acquired infection. Duration of catheterization is the dominant risk factor for hospitalacquired urinary tract infection. Physicians are often unaware that their patients have a urinary catheter, and these "forgotten" catheters are frequently unnecessary. Methods: A controlled trial, using a pretest-posttest design, was conducted on four hospital wards at an academic medical center. A simple written reminder was designed to aid the hospitalized patient's team in remembering that the patient had a urinary catheter. Two of the four wards were assigned to the intervention group, and two served as controls. A research nurse monitored the urethral catheter status of each patient daily. Results: A total of 5,678 subjects were evaluated. After adjusting for age, sex, and length of stay, the average proportion of time patients were catheterized increased by 15.1% in the control group but decreased by 7.6% in the intervention group in the intention-totreat analysis (p = .007). There was no significant difference in urethral recatheterizations between intervention and control groups. The hospital cost savings provided by the intervention offset the necessary costs of this nurse-based intervention. Conclusion: In the approximately 90% of U.S. hospitals currently without computerized order-entry systems, a written reminder should be considered as one method for improving the safety of hospitalized patients.