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A Stepwise Strategy Significantly Reduced Medical Intensive Care Unit Urinary Catheter Utilization Rates FREE TO VIEW

Pavan Irukulla, MBBS; Yizhak Kupfer, MD; Chanaka Seneviratne, MD; Manveen Dassan, MD; Amit Shenoy, MBBS; Pavan Gorukanti, MD; Amit Agarwal, MD; Richard Savel, MD; Tae Chang, PharmD; Taek Yoon, MD
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Maimonides Medical Center, Brooklyn, NY, Brooklyn, NY

Chest. 2015;148(4_MeetingAbstracts):488A. doi:10.1378/chest.2269293
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SESSION TITLE: Process Improvement in Obstructive Lung Disease Education, Pneumonia Readmissions and Rapid Response Systems II

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Many hospitalized patients have an indwelling urinary catheter (IUC), but studies have shown that they are inappropriate in upto one-third of the time. We report our successful efforts to significantly reduce IUC utilization in a medical intensive care unit (MICU).

METHODS: In January 2012 a performance improvement goal of our closed MICU was developed to reduce usage of IUC’s. Infection control calculates the urinary catheter utilization rates by dividing the number of IUC days to over all MICU patient days. We used 3 step intervention implementation to decrease urinary catheter utilization rates. In March 2012, intense education of physicians, fellows, residents and nurses was implemented. Initially, allowed indications of an IUC included high risk of decubitus, renal failure, urinary retention and hemodynamic monitoring. In January 2013 we narrowed criteria to urinary retention, high risk of urinary retention and initial treatment of renal failure and hemodynamic monitoring. In January 2014 we initiated the use of sonographic bladder scanning to detect urinary retention.

RESULTS: Our baseline utilization rate was 92.3%. After initial intervention our utilization rates dropped to 55%, almost a 40% decrease. The rates were stable until second intervention which further dropped the rate gradually to 25 - 30%, which is a further decrease of 25%. The third intervention continued to reduce the rate to 15 - 20%, a further decrease of 10 to 15%. Over all IUC utilization decreased from 92.3% to 15% an absolute reduction of 77.3%.

CONCLUSIONS: Intensive education and strict monitoring of IUC indications can result in a significant decrease of IUC utilization in a closed MICU.

CLINICAL IMPLICATIONS: An intensive educational program with daily focus on appropriateness of IUC use can dramatically reduce utilization of IUC's in a MICU. Such a program can reduce catheter associated Urinary tract Infections.

DISCLOSURE: The following authors have nothing to disclose: Pavan Irukulla, Yizhak Kupfer, Chanaka Seneviratne, Manveen Dassan, Amit Shenoy, Pavan Gorukanti, Amit Agarwal, Richard Savel, Tae Chang, Taek Yoon

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