J. N. Nathwani1, K. E. Law2, R. D. Ray1, B. R. O’Connell Long1, R. M. Fiers1, A. D. D’Angelo1, C. M. Pugh1 1University Of Wisconsin,General Surgery,Madison, WI, USA 2University Of Wisconsin,Industrial And Systems Engineering,Madison, WI, USA
Introduction: Urinary catheter insertion is a common procedure performed in hospitals. Improper catheterization can lead to unnecessary catheter associated urinary tract infections and urethral trauma, increasing patient morbidity. To prevent such complications, guidelines were created by the American College of Surgeons on how to insert and troubleshoot urinary catheters. As nurses have an increasing responsibility for catheter placement, resident responsibility has shifted to more complex scenarios. This study examines the clinical decision making skills of surgical residents during simulated urinary catheter scenarios. We hypothesize that while placing catheters, residents will make consistent choices for initial and subsequent catheters.
Methods: Forty-five general surgery residents (PGY 2-4) in Midwest training programs were presented with three of four urinary catheter scenarios. Scenarios varied in difficulty: A) female trauma patient with a bladder injury, B) female patient with labial constriction, C) male patient with complete obstruction of the urinary tract, and D) male patient with benign prostatic hypertrophy with partial blockage of the urinary tract. Residents were allowed 15 minutes to complete three scenarios. Scenario A was performed by all residents. Residents were presented with five different catheter choices and the option to consult an on-call Urologist. A Chi Squared test was performed to examine the relation between initial and subsequent catheter choices and to evaluate for consistency of decision making for each scenario.
Results: All (N=45) residents performed scenario A; 45% performed scenario B; 67% performed scenario C and 82% performed scenario D. For initial attempt for scenario A-C, the 16 French Foley catheter was the most common choice (38%, 54%, 50%, p's<.001), whereas for scenario D, the 16 French Coude was the most common choice (37%, p<.01). The variation in first choice of catheters is shown in Table 1. Residents were most likely to be successful in achieving urine output in the initial catheterization attempt (p<.001). Chi-Square analyses showed no relationship between residents’ first and subsequent catheter choices for each scenario (p’s >.05).
Conclusion: Evaluation of clinical decision making shows initial catheter choice may have been deliberate based on patient background, as evidenced by the most popular choice in scenario D. Analyses of subsequent choices in each of the catheterization models reveal inconsistency. These findings suggest a possible lack of competence or inadequate training in clinical decision making with regards to urinary catheter choices in residents.
