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Are physicians aware of which of their patients have indwelling urinary catheters?

  • Sanjay Saint
    Correspondence
    Requests for reprints should be addressed to Sanjay Saint, MD, MPH, University of Michigan Health System, 3116 Taubman Center, Box 0376, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109-0376
    Affiliations
    Department of Internal Medicine (SS, MLB, UDP, SJB, TPH), University of Michigan Medical School, Ann Arbor, Michigan;USA

    Veterans Affairs Center for Practice Management and Outcomes (SS, JKZ, SJB, BAL, TPH), Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan; USA
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  • Jeff Wiese
    Affiliations
    Department of Medicine (JW), University of California, San Francisco School of Medicine, San Francisco, California; USA
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  • John K Amory
    Affiliations
    Department of Medicine (JKA), University of Washington School of Medicine, Seattle, Washington; USA

    Primary and Specialty Medical Care (JKA, BAL), Veterans Affairs Puget Sound Health Care System, Seattle, Washington; USA
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  • Michael L Bernstein
    Affiliations
    Department of Internal Medicine (SS, MLB, UDP, SJB, TPH), University of Michigan Medical School, Ann Arbor, Michigan;USA
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  • Uptal D Patel
    Affiliations
    Department of Internal Medicine (SS, MLB, UDP, SJB, TPH), University of Michigan Medical School, Ann Arbor, Michigan;USA
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  • Judith K Zemencuk
    Affiliations
    Veterans Affairs Center for Practice Management and Outcomes (SS, JKZ, SJB, BAL, TPH), Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan; USA
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  • Steven J Bernstein
    Affiliations
    Department of Internal Medicine (SS, MLB, UDP, SJB, TPH), University of Michigan Medical School, Ann Arbor, Michigan;USA

    Veterans Affairs Center for Practice Management and Outcomes (SS, JKZ, SJB, BAL, TPH), Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan; USA
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  • Benjamin A Lipsky
    Affiliations
    Veterans Affairs Center for Practice Management and Outcomes (SS, JKZ, SJB, BAL, TPH), Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan; USA

    Primary and Specialty Medical Care (JKA, BAL), Veterans Affairs Puget Sound Health Care System, Seattle, Washington; USA
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  • Timothy P Hofer
    Affiliations
    Department of Internal Medicine (SS, MLB, UDP, SJB, TPH), University of Michigan Medical School, Ann Arbor, Michigan;USA

    Veterans Affairs Center for Practice Management and Outcomes (SS, JKZ, SJB, BAL, TPH), Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan; USA
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      Abstract

      PURPOSE: Although infections associated with indwelling urinary catheters are common, costly, and morbid, the use of these catheters is unnecessary in more than one-third of patients. We sought to assess whether attending physicians, medical residents, and medical students are aware if their hospitalized patients have an indwelling urinary catheter, and whether physician awareness is associated with appropriate use of these catheters.
      METHODS: The physicians and medical students responsible for patients admitted to the medical services at four university-affiliated hospitals were given a list of the patients on their service. For each patient, the provider was asked: “As of yesterday afternoon, did this patient have an indwelling urethral catheter?” Respondents’ answers were compared with the results of examining the patient.
      RESULTS: Among 288 physicians and students on 56 medical teams, 256 (89%) completed the survey. Of 469 patients, 117 (25%) had an indwelling catheter. There were a total of 319 provider-patient observations among these 117 patients. Overall, providers were unaware of catheterization for 88 (28%) of the 319 provider-patient observations. Unawareness rates by level of training were 21% for students, 22% for interns, 27% for residents, and 38% for attending physicians (P = 0.06). Catheter use was inappropriate in 36 (31%) of the 117 patients with a catheter. Providers were unaware of catheter use for 44 (41%) of the 108 provider-patient observations of patients who were inappropriately catheterized. Catheterization was more likely to be appropriate if respondents were aware of the catheter (odds ratio = 3.7; 95% confidence interval, 2.1 to 6.7, P <0.001).
      CONCLUSION: Physicians are commonly unaware that their patients have an indwelling urinary catheter. Inappropriate catheters are more often “forgotten” than appropriate ones. System-wide interventions aimed at discontinuing unnecessary catheterization seem warranted.
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