Brief observation
Computer-based order entry decreases duration of indwelling urinary catheterization in hospitalized patients

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Methods

All inpatients at the VA Puget Sound Health Care System are cared for by teams of resident physicians supervised by University of Washington faculty. Patients on the medicine and cardiology services are predominantly housed on two hospital wards (second and fourth floor), with most of each team’s patients on a single ward. During the first 8 weeks of the study, the fourth floor served as the study ward and the second floor served as the control ward; during the second 8 weeks, the second floor

Results

There were 742 patients admitted to the medicine and cardiology services during the study; 94 patients were excluded following transfer to a ward or treating specialty not included in the study. There was no statistically significant difference between the rates of indwelling urinary catheter use between study wards (12% [36/311]) and control wards (10% [34/337]; P = 0.15). Of the 36 patients who were on a study ward when the catheter was placed, 33 (92%) had a charted order. Of the 34 patients

Discussion

Indwelling urinary catheterization is a common practice in hospitalized patients. Because these devices cause patient discomfort and are responsible for substantial morbidity (17), they have been called a “one-point restraint” (18). Even when inserted for an appropriate indication, the catheter is often left in place longer than needed (2). The most important risk factor for catheter-associated urinary tract infection is the duration of catheterization 3, 4. Because preventing catheter-related

Acknowledgements

We thank Patricia Hoey, RPh, for computer assistance; Mari Perrotti, RN, and Donna McGrann, RN, for nursing administrative support; Samuel Kaufman, MA, for statistical assistance; and the house staff of the University of Washington, Department of Medicine.

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This project was supported by a grant from the Research Foundation for the Prevention of Complications Associated with Health Care, Washington D.C., and by the Department of Veterans Affairs. Dr. Saint is supported by a Career Development Award from the Health Services Research & Development Program of the Department of Veterans Affairs and a Patient Safety Developmental Center grant (P20-HS11540) from the Agency for Healthcare Research and Quality, Rockville, Maryland.

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