M. W. Wandling1,2,3,4, K. Schelling4, A. Mikolajczak4, W. Wilson4, C. M. Gonzalez4,5, C. Perry4, K. Y. Bilimoria1,2,3,4, A. D. Yang1,2,3,4 1Northwestern University Feinberg School Of Medicine,Department Of Surgery,Chicago, IL, USA 2Northwestern University Feinberg School Of Medicine,Surgical Outcomes & Quality Improvement Center,Chicago, IL, USA 3Northwestern University Feinberg School Of Medicine,Institute For Public Health And Medicine, Center For Healthcare Studies,Chicago, IL, USA 4Northwestern Medicine,Chicago, IL, USA 5Northwestern University Feinberg School Of Medicine,Department Of Urology,Chicago, IL, USA
Introduction:
Catheter-associated urinary tract infection (CAUTI) is a major, preventable source of hospital-acquired infection. Our hospital has performed poorly in regard to CAUTI rates in surgical patients, ranking in the bottom 10-20% of ACS NSQIP hospitals. Since CAUTI rate is a publicly reported measure linked to healthcare quality and financial reimbursement, we aimed to decrease CAUTI rates by focusing on both reducing catheter utilization in the operating room (OR) and removing them in the immediate post-operative period.
Methods:
A multi-disciplinary team of stakeholders involved in the peri-operative care of surgical patients used DMAIC methodology for this project. Institutional data were analyzed before and after our interventions. Goals were set to: 1) decrease the number of catheters inserted in the OR for cases less than three hours, 2) increase the number of catheters removed prior to transfer to the floor, 3) stimulate culture change regarding surgeons’ utilization of urinary catheters, and 4) decrease CAUTI rates attributable to catheters inserted in the OR. We implemented a formal pre- and post-operative discussion of catheter indication and necessity with the surgical team (pre-operative) and attending surgeon (post-operative) into the OR nursing procedural protocol. Documentation of compliance with each intervention was mandated to facilitate the audit and feedback of performance. Six months of post-intervention data regarding performance on each of our goals was collected and analyzed.
Results:
A mean of 437 catheters per month were inserted for cases lasting less than three hours prior to the intervention, compared to a mean of 391 catheters per month post-intervention (p=0.044). Utilization of catheters for cases shorter than three hours decreased from 23.7% pre-intervention to 20.9% post-intervention (p=0.001), representing an 11.8% relative reduction in overall catheter insertion. In addition to reducing overall utilization, the percent of catheters removed prior to the patient transferring to the floor increased from 18.3% to 21.0% (p=0.252). Lastly, the rate of surgical CAUTI decreased from 2.5 occurrences per month prior to intervention to 0.3 occurrences per month post-intervention (p=0.006), including zero occurrences in four out of the six months following intervention. This represents an 89.1% decrease in the rate of surgical CAUTI.
Conclusion:
By using rigorous, data-driven process improvement methodology, our multi-disciplinary team was able to identify and successfully implement novel interventions aimed at decreasing the rate of CAUTI among surgical patients at our institution. We successfully met our goals, most notably dramatically decreasing the rate of CAUTI in surgical patients. These interventions have led to institutional changes in practice regarding peri-operative catheter insertion that will continue to decrease CAUTI rates and improve the quality of surgical care.