A study of 1,586 hospitalized patients age 70 and older at two Ohio hospitals indicates that 24 percent were given medically unnecessary urinary catheters, according to investigators led by a researcher at the San Francisco VA Medical Center.
None of the 378 catheterized patients had a medical condition indicating a need for a catheter. Among patients 85 or older, the rate of unnecessary catheterization was 32 percent.
The risk of medically inappropriate catheterization was also higher among women, patients with disability or dementia, and patients admitted with a geriatric condition such as confusion or frequent falls.
The study appears in the December, 2005 issue of the Journal of Patient Safety, which has just been published.
The study authors note that, in previous research, catheterization has been shown to cause urinary infection in one fourth of patients catheterized.
"This highlights the fact that the people who are most likely to suffer the adverse effects of a urinary tract infection are exactly the people who seem to be getting unnecessary catheterizations," observes principal investigator Seth Landefeld, MD, associate chief of staff of geriatrics and extended care at SFVAMC and Senior Scholar in the VA National Quality Scholar Program.
The study identified nine specific risk factors for unnecessary catheterization: female gender, chronic illness, cognitive impairment, incontinence, inability to carry out common activities of daily living, a physician's order for bed rest, and three geriatric conditions -- confusion, falls, and failure to thrive at home. Patients with five or more risk factors had a 50% risk of being catheterized unnecessarily.
"None of these factors are in themselves an indication for having a catheterization," says Landefeld, who is also a professor of medicine at the University of California, San Francisco.
The study did not examine the question of why unnecessary catheters are being placed. "Other studies have found that most doctors don't know whether their patient has a catheter in place or not," Landefeld notes. "It's something that happens frequently for reasons that have not been fully teased out."
When the reasons are eventually determined, he says, the next step would be think about ways to decrease unnecessary catheter use. "It's like hand washing in hospitals, which has become much more common recently thanks to interventions that encourage hospital staff to modify their behavior," he says. "We need very obvious approaches that will get people to think three times before placing the catheter -- and once it's in, to think how quickly they can get it out."
Landefeld says that he and his fellow researchers have completed a follow up study on what happens to patients who have been catheterized unnecessarily: "Are they more likely to decline and be unable to care for themselves? Are they more likely to die, or go to a nursing home?" That study is currently under peer review.
Co-authors of the study were Jayna M. Holyroyd-Leduc, MD, currently of the University of Toronto and of SFVAMC at the time of the study; Laura P. Sands, PhD, of Purdue University, Indiana; Steven R. Counsell, MD, of the Indiana University School of Medicine; Robert M. Palmer, MD, MPH, of the Cleveland Clinic, Ohio; and Denise M. Kresevic, RN, PhD, of Louis Stokes Cleveland VAMC and University Hospitals of Cleveland.
The study was funded by grants from the National Institute on Aging and the Summa Health Foundation, and by support from the Department of Veterans Affairs.
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