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Written reminders can reduce the length of time patients have urinary catheters

The longer a hospitalized patient has an indwelling urinary catheter, the greater the risk of developing a urinary tract infection. Treating these infections costs at least $500 per episode. Yet, over one-third of attending physicians are unaware that their own hospitalized patients have indwelling urinary catheters. These "forgotten" catheters are frequently unnecessary and could have been taken out earlier. For hospitals in the United States currently without computerized order-entry systems, a simple written reminder can reduce the average time that patients are catheterized and, thus, reduce their risk of infection.

Researchers, supported in part by the Agency for Healthcare Research and Quality (HS11540), designed a simple reminder, similar to an antibiotic stop-order, to remind physicians and nurses that the patient had a urinary catheter. Physicians of patients in two hospital wards at one medical center received the written reminder, which was attached to the charts of patients who had been catheterized for 48 hours. The physicians of patients in two other wards served as controls and did not receive the reminder.

A total of 5,678 patients were evaluated. The average amount of time patients were catheterized decreased by 7.6 percent in the reminder group but increased by 15.1 percent in the control group over their respective pre-intervention baselines. There was no significant difference in urethral re-catheterizations between reminder and control groups. Also, the hospital cost savings provided by the written reminders offset the necessary costs.

More details are in "A reminder reduces urinary catheterization in hospitalized patients," by Sanjay Saint, M.D., M.P.H., Samuel R. Kaufman, M.A., Maureen Thompson, R.N., M.S.N., and others, in the August 2005 Journal on Quality and Patient Safety 31(8), pp. 455-462.

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