Old, female and headed for the ED? Bring someone along who can speak up for you

I accompanied a patient to the emergency department the other day and was glad I did. There’s just too much going on for an ailing patient to process alone, and it’s important to have someone there to be a second set of ears and eyes, provide moral support, ask questions, and –when needed– perform a quality control role. (I was actually very impressed with the place we went and we didn’t have any serious problems on this visit.)

A HealthLeaders article (Half of Elderly Women Unnecessarily Catheterized in ED) about an American Journal of Infection Control study provided a reminder of the necessity of bringing along a companion who can speak up. From the article:

The report… raises questions about whether elderly women are being unnecessarily exposed to risk of infection, a known hazard of urinary catheterization.

The researchers examined 532 instances of catheter placement and found that 48.3%, or 58 of those patients who were female and age 80 or older did not have indications for catheter placement.

Overall, for both men and women regardless of age, about one sixth of ED patients had a UC placed without a clear reason. “Women were twice as likely as men to have a nonindicated UC placement,” they wrote. “About 40% if the patients had no documented physician’s order for placement.”

The authors acknowledge that the catheterization practice may reflect other factors that weren’t captured in their review, such as dementia, urinary incontinence and immobility, which may have been reasons for the catheter placement.

One reasonĀ  –though not the only one– that patients like this are unnecessarily catheterized is for the convenience of the hospital staff. If the patient has someone there with them they can at least ask if the catheterization is appropriate.

I’m always wary of industries that set up or allow processes that are designed to increase the convenience of staff at the cost of the customer. The airline industry is an example. Flight attendants and pilots cut to the front of the security line. Sure, lines are a pain and staff need to get to the plane, but so do passengers.

November 2, 2010

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