Some involved computer-generated stop orders, whereas others used a ... sticker...

Research has shown that urinary catheters are often placed unnecessarily, remain in place without the awareness of physicians, and not removed promptly when no longer required. Prolonged catheterization, besides its detrimental effects on patient comfort, mobility and length of hospitalization, is a major risk factor for catheter-associated urinary tract infection (CAUTI)—a complication for which US hospitals no longer receive additional payment from Medicare/Medicaid on account of its preventability. Several systems that remind clinicians about the presence of an indwelling urinary catheter have been developed with the aim of reducing the frequency of unnecessary catheterization and, consequently, the rate of CAUTI episodes. Meddings and colleagues at the University of Michigan performed a systematic review and meta-analysis to evaluate the benefits of these reminder systems.

The analysis included 14 studies; 9 were of reminder-only systems (physicians or nurses advised that a patient's catheter was still in place and that its removal was recommended if no longer clinically necessary) and 5 investigated stop-order interventions (clinicians prompted to remove the catheter after a set time period or when prespecified clinical conditions were met). These interventions varied in terms of their technological sophistication. Some involved computer-generated stop orders, whereas others used a simple reminder sticker attached to the patient's chart or Foley bag.

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Overall, the use of reminder or stop-order systems reduced the rate of CAUTI by 52% (P <0.001), and decreased the mean duration of catheterization by 37% (2.6 days per patient). In pooled analyses, only stop-order interventions resulted in a statistically significant decrease in duration of catheterization. Recatheterization rates were not affected by either intervention type.

The analysis was limited by the fact that only one of the included studies had a randomized, controlled design. Nevertheless, the authors conclude that the use of reminder and stop-order systems can markedly reduce the frequency of CAUTI episodes and the duration of catheterization without increasing the likelihood of recatheterization. As the apparent benefits of these interventions did not seem to be affected by their level of technological complexity, they represent low-cost strategies that can be easily implemented in all systems of health care.