Eavesdropping on the hospitalists: Is that catheter needed?

I enjoy reading Today’s Hospitalist because it provides a real-world view into what goes on in hospitals. The monthly magazine is aimed at hospitalists practicing in community settings and deals with issues such as medical errors, managing relationships, workloads, and billing.

Some of the things I read about that occur in a hospital are alarming –but overall I think it’s best to confront reality. (It certainly reinforces my view that any hospitalized patient should bring along an advocate, preferably an MD).

A couple articles in the current edition caught my eye. The first was a news brief on preventing urinary tract infections. It reported on a meta-analysis that showed that reminders and stop orders could cut catheterization-related infections by more than half and length of catheterization by more than one-third. From the Briefs page:

[Reminders] translated to 2.61 fewer days that patients were catherized.

According to the study, many catheters aren’t necessary, and physicians weren’t aware of how long catheters remain in place.

So just to make it clear for patients: hospital staff often place catheters for their own convenience or because it’s standard procedure, and the result for the patient is more discomfort, infections, and longer stays. Meanwhile doctors are clueless about what’s going on. This is a good example of an area where an advocate can ask whether a catheter is needed and –once placed– when it can be removed.

A patient could be forgiven for expecting that catheters would only be placed when needed and that someone was paying attention to when they should be removed.

September 13, 2010

7 thoughts on “Eavesdropping on the hospitalists: Is that catheter needed?”

  1. Pingback: What is it with hospitalists and the big cats? | Health Blog
  2. Uh, I have to object to some of this david. I am a practicing hospitalist, and “Meanwhile doctors are clueless about what’s going on” is borderline (or actually over the border) offensive (very fox newsy though). I could say that MBA’s trying to understand hospital medicine as a widget based service business are clueless, and it wouldn’t sit to well; why not try some more professional and less inflammatory language. There are certainly poorly run hospital medicine programs and well run ones, but condemning the entire profession is naive.

    Patients with catheters are shown on a dashboard in the EHR at our hospital and we have to decide with the nurse daily can we remove it. As a protocol all elderly patients have automatic criteria for removal.

    There are many medical reasons why we need to insert catheters, admittedly some is for staff convenience, but one has to balance the risk of infection with the risk of bed sores from patients who urinate on themselves and get skin break down; remember that CMS has made skin break down a “never event”, which makes us tilt away form that risk. With patients who we are worried about their fluid status it is the only truly reliable way to measure urine output, but as a doctor we do understand the risks, but have a complex and conflicting set of criteria around them; it’s not as simple as a quick blog riff.

  3. You raise some very good points here.

    As a physician, I’ve rounded on too many hospitalized patients (thousands?) who, in my opinion, didn’t really need their foley catheters or second IV’s. As a patient, I’m wary of any unessential catheters – they’re annoying and a potential source of infection, besides costly.

  4. Pingback: Is that catheter needed? (Take 2) | Health Blog

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