Elsevier

The Surgeon

Volume 13, Issue 1, February 2015, Pages 15-18
The Surgeon

Avoidable iatrogenic complications of male urethral catheterisation and inadequate intern training: A 4-year follow-up post implementation of an intern training programme

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Abstract

Objective

To assess the impact of a structured training programme in urethral catheterisation (UC) targeted at newly qualified junior doctors on rates of iatrogenic catheter morbidity within a tertiary care referral centre.

Subjects and methods

Male UC-related morbidities were retrospectively identified from our computerised inpatient urology consultation system over a 1-year period from July 2010 to June 2011. Relevant medical records were also reviewed. Results were compared with an initial study performed between July 2006 and June 2007, prior the introduction of a structured training programme in our institution. An anonymous questionnaire was used for the subjective assessment of interns about confidence in catheterising post introduction of the programme.

Results

Of 725 urological consultations, 29 (4%) were related to complications arising from male UC during the 1 year period. This reflected a statistically significant decrease when compared to our 2007 figures, 51/864 (6%) (p < 0.05). Again, the most common indication for UC was monitoring urinary output for acute medical illness (19/29, 66%). The most common complication was urethral trauma (16/29, 55%). Of the 29 cases of UC-related morbidity, 18 (62%) resulted from interns performing UC, a decrease of 12% from our original paper. A drop of 27% was seen in the rates of UC related morbidity attributable to interns during the first 6 months of internship (July–December). Overall, 70% (vs 40% original study) of interns felt that their practical training was adequate since introduction of the programme (p < 0.01) with 53% considering theoretical training adequate (vs 16% original study (p < 0.01). When asked were they confident in performing UC, 63% said they were compared to 35% before introduction of the programme (p < 0.05).

Conclusions

UC-related iatrogenic morbidity is not uncommon even in a tertiary-care teaching hospital. Implementation of a structured training programme in UC prior to the commencement of intern year has been shown to result in a significant decrease in the amount of iatrogenic UC related morbidity.

Introduction

Urinary catheterisation (UC) is common practical procedure that newly qualified doctors are required to perform on a regular basis. Although seldom serious, iatrogenic urethral injury associated with catheter insertion can result in long-term sequelae including strictures, incontinence, erectile dysfunction, and infertility.1 We had previously reported that UC related iatrogenic morbidity was a common occurrence, consisting of 6% of referrals to our urology department.2 We had also reported that three quarters of catheter related morbidities occurred when the procedure was performed by interns and that rates of iatrogenic injury attributable to them steadily decreased over their first working year.2

Various other authors have questioned whether junior doctors training in UC prior to their regular and close involvement in the care of patients is sufficient.1, 3, 4, 5 Bigot et al. recently reported that of 277 final year medical students surveyed only 26% considered that they were able to confidently perform UC in males and 38.3% in females at the end of their medical training.3

Our results previously suggested that many of these catheter related injuries were potentially avoidable and that implementation of an appropriate training programme for newly qualified doctors may decrease occurrence. The aim of this follow up study from the same tertiary referral centre was to assess the impact of such a structured training programme targeted at newly qualified junior doctors prior to the commencement of their intern year.

Section snippets

Methods

Male UC-related morbidities were retrospectively identified from our computerised inpatient urology consultation system over a 1-year period from July 2010 to June 2011. Relevant medical records were also reviewed to obtain information on patient demographics, co-morbidities, indication for and complications of UC, seniority of doctors involved in UC and further management of the complications. Results were compared with an initial study performed in 2007, prior to the introduction of a

Results

Of 725 urological consultations, 29 (4%) were related to complications arising from male UC during the 1 year period. This reflected a statistically significant decrease when compared to the 2007 figures, 51/864 (6%) (p < 0.05). Again the most common indication for UC was monitoring urinary output for acute medical illness (19/29, 66%). The distribution of complications of UC are shown in Table 1; the most common complication was urethral trauma (16/29, 55%), 45% of patients developed visible

Discussion

UC is a commonly performed procedure in the acute hospital setting, with certain studies reporting up to 25% of patients requiring it at some point during their admission.6 Although overall rates of serious iatrogenic catheter trauma are relatively low, they still occur and are a potentially avoidable morbidity.7, 8

We had previously reported that rates of urethral injury attributable to newly qualified junior doctors were significantly higher than their more senior colleagues2 and that the

Conclusion

Iatrogenic urethral trauma is a relatively common problem even in large teaching hospitals. We have shown that by introducing a focused training programme in UC prior to the commencement of intern year that rates of catheter morbidity can be significantly reduced. We believe such training programmes should become standard and are an important element in preparing students for the transfer to junior clinicians.

References (11)

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