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Hendren S, Ameling J, Rocker C, Sulich C, Greene MT, Meddings J. Validation of measures for perioperative urinary catheter use, urinary retention, and urinary catheter-related trauma in surgical patients. Am J Surg 2024; 228:199-205. [PMID: 37798151 PMCID: PMC10922583 DOI: 10.1016/j.amjsurg.2023.09.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/12/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The effects of non-infectious urinary catheter-related complications such as measurements of indwelling urinary catheter overuse, catheter-related trauma, and urinary retention are not well understood. METHODS This was a retrospective cohort study of 200 patients undergoing general surgery operations. Variables to measure urinary catheter use, trauma, and retention were developed, then surgical cases were abstracted. Inter- and intra-rater reliability were calculated for measure validation. RESULTS 129 of 200 (65%) had an indwelling urinary catheter placed at the time of surgery. 32 patients (16%) had urinary retention, and variation was observed in the treatment of urinary retention. 12 patients (6%) had urinary trauma. Rater reliability was high (>90% agreement for all) for the dichotomous outcomes of urinary catheter use, urinary catheter-related trauma, and urinary retention. CONCLUSIONS This study suggests a persistent high rate of catheter use, significant rates of urinary retention and trauma, and variation in the management of retention.
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Affiliation(s)
- Samantha Hendren
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
| | - Jessica Ameling
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - Cheryl Rocker
- Michigan Surgical Quality Collaborative, Ann Arbor, MI, USA.
| | - Catherine Sulich
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - M Todd Greene
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Jennifer Meddings
- Division of General Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA; Division of General Pediatrics, Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, MI, USA.
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Metersky ML, Wang Y, Klompas M, Eckenrode S, Mathew J, Krumholz HM. Temporal trends in postoperative and ventilator-associated pneumonia in the United States. Infect Control Hosp Epidemiol 2023; 44:1247-1254. [PMID: 36326283 DOI: 10.1017/ice.2022.264] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine change in rates of postoperative pneumonia and ventilator-associated pneumonia among patients hospitalized in the United States during 2009-2019. DESIGN Retrospective cohort study. PATIENTS Patients hospitalized for major surgical procedures, acute myocardial infarction, heart failure, and pneumonia. METHODS We conducted a retrospective review of data from the Medicare Patient Safety Monitoring System, a chart-abstraction-derived database including 21 adverse-event measures among patients hospitalized in the United States. Changes in observed and risk-adjusted rates of postoperative pneumonia and ventilator-associated pneumonia were derived. RESULTS Among 58,618 patients undergoing major surgical procedures between 2009 and 2019, the observed rate of postoperative pneumonia from 2009-2011 was 1.9% and decreased to 1.3% during 2017-2019. The adjusted annual risk each year, compared to the prior year, was 0.94 (95% CI, 0.92-0.96). Among 4,007 patients hospitalized for any of these 4 conditions at risk for ventilator-associated pneumonia during 2009-2019, we did not detect a significant change in observed or adjusted rates. Observed rates clustered around 10%, and adjusted annual risk compared to the prior year was 0.99 (95% CI, 0.95-1.02). CONCLUSIONS During 2009-2019, the rate of postoperative pneumonia decreased statistically and clinically significantly in among patients hospitalized for major surgical procedures in the United States, but rates of ventilator-associated pneumonia among patients hospitalized for major surgical procedures, acute myocardial infarction, heart failure, and pneumonia did not change.
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Affiliation(s)
- Mark L Metersky
- Division of Pulmonary, Critical Care Medicine and Sleep Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Yun Wang
- Richard and Susan Smith Center for Outcomes Research in Cardiology, Division of Cardiology, Beth Israel Deaconess Medical, Harvard Medical School, Boston, Massachusetts
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sheila Eckenrode
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Jasie Mathew
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Harlan M Krumholz
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
- Section of General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
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John G, Arcens M, Berra G, Garin N, Carballo D, Carballo S, Stirnemann J. Risks and benefits of urinary catheterisation during inpatient diuretic therapy for acute heart failure: a retrospective, non-inferiority, cohort study. BMJ Open 2022; 12:e053632. [PMID: 37129085 PMCID: PMC9362793 DOI: 10.1136/bmjopen-2021-053632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives Patients with acute congestive heart failure (HF) regularly undergo urinary catheterisation (UC) at hospital admission. We hypothesised that UC has no clinical benefits with regard to weight loss during inpatient diuretic therapy for acute congestive HF and increases the risk of urinary tract infection (UTI). Design Retrospective, non-inferiority study. Setting Geneva University Hospitals’ Department of Medicine, a tertiary centre. Participants In a cohort of HF patients, those catheterised within 24 hours of diuretic therapy (n=113) were compared with non-catheterised patients (n=346). Primary and secondary outcome measures The primary endpoint was weight loss 48 hours after starting diuretic therapy. Secondary endpoints were time needed to reach target weight, discontinuation of intravenous diuretics and resolution of respiratory failure. Complications included the time to a first UTI, first hospital readmission and death. Results A total of 48-hour weight loss was not statistically different between groups and the adjusted difference was below the non-inferiority boundary of 1 kg (0.43 kg (95% CI: −0.03 to 0.88) in favour of UC, p<0.01 for non-inferiority). UC was not associated with time to reaching target weight (adjusted HR 1.0; 95% CI: 0.7 to 1.5), discontinuation of intravenous diuretics (aHR 0.9; 95% CI: 0.7 to 1.2) or resolution of respiratory failure (aHR 1.1; 95% CI: 0.5 to 2.4). UC increased the risk of UTI (aHR 2.5; 95% CI: 1.5 to 4.2) but was not associated with hospital readmission (aHR 1.1; 95% CI: 0.8 to 1.4) or 1-year mortality (aHR 1.4; 95% CI: 1.0 to 2.1). Conclusion In this retrospective study, with no obvious hourly diuresis-based diuretic adjustment strategy, weight loss without UC was not inferior to weight loss after UC within 24 hours of initiating diuretic treatment. UC had no impact on clinical improvement and increased the risk of UTI. This evidence, therefore, argues against the systematic use of UC during a diuretic therapy for HF.
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Affiliation(s)
- Gregor John
- Department of Medicine, Université de Genève, Geneva, Switzerland
- Department of Internal Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland
- Department of Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Marc Arcens
- Department of Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Gregory Berra
- Department of Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Nicolas Garin
- Department of Medicine, Université de Genève, Geneva, Switzerland
- Department of Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - David Carballo
- Department of Medicine, Université de Genève, Geneva, Switzerland
- Department of Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Sebastian Carballo
- Department of Medicine, Université de Genève, Geneva, Switzerland
- Department of Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | - Jerome Stirnemann
- Department of Medicine, Université de Genève, Geneva, Switzerland
- Department of Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
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Metersky ML, Eldridge N, Wang Y, Eckenrode S, Galusha D, Jaser L, Mathew J, Angus S, Nardino R. Rates of Adverse Events in Hospitalized Patients After Summer-Time Resident Changeover in the United States: Is There a July Effect? J Patient Saf 2022; 18:253-259. [PMID: 34387249 PMCID: PMC8831642 DOI: 10.1097/pts.0000000000000887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to determine whether patients in teaching hospitals are at higher risk of suffering from an adverse event during the summer trainee changeover period. METHODS We performed a retrospective analysis of data from the Medicare Patient Safety Monitoring System, a medical-record abstraction-based database in the United States. Hospital admissions from 2010 to 2017 for acute myocardial infarction, heart failure, pneumonia, or a major surgical procedure were studied. Admissions were divided into nonsurgical (acute myocardial infarction, heart failure, or pneumonia) and surgical. Adverse event rates in July/August were compared with the rest of the year. Hospitals were stratified into major teaching, minor teaching, or nonteaching. Results were adjusted for patient demographics, comorbidities, and hospital characteristics. Outcomes were the adjusted odds of having at least 1 adverse event in July/August versus the rest of the year. RESULTS We included 185,652 hospital admissions. The adjusted odds ratios (ORs) of suffering from at least one adverse event in a major teaching hospital in July/August was 0.83 (95% confidence interval [CI], 0.69-0.98) for nonsurgical patients and 1.09 (95% CI, 0.84-1.40) for surgical patients. In minor teaching hospitals, the adjusted ORs were 0.96 (95% CI, 0.88-1.04) for nonsurgical patients and 0.99 (95% CI, 0.87-1.12) for surgical patients. In nonteaching hospitals, the adjusted ORs were 0.98 (95% CI, 0.91-1.06) for nonsurgical patients and 1.10 (95% CI, 0.96-1.24) for surgical patients. CONCLUSIONS Patients admitted to teaching hospitals in July/August are not at increased risk of adverse events. These findings should reassure patients and medical educators that patients are not excessively endangered by admission to the hospital during these months.
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Affiliation(s)
| | - Noel Eldridge
- Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, MD
| | | | - Sheila Eckenrode
- From the Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven
| | - Deron Galusha
- Section of General Internal Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven
| | | | - Jasie Mathew
- From the Center for Outcomes Research and Evaluation, Yale New Haven Health Services Corporation, New Haven
| | - Steven Angus
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT
| | - Robert Nardino
- Department of Medicine, University of Connecticut School of Medicine, Farmington, CT
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Time Trends in Patient Characteristics and In-Hospital Adverse Events for Primary Total Knee Arthroplasty in the United States: 2010-2017. Arthroplast Today 2021; 11:157-162. [PMID: 34604486 PMCID: PMC8473015 DOI: 10.1016/j.artd.2021.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/22/2022] Open
Abstract
Background Perioperative care for total knee arthroplasty (TKA) has improved over time. We present an analysis of inpatient safety after TKA. Methods 14,057 primary TKAs captured by the Medicare Patient Safety Monitoring System between 2010 and 2017 were retrospectively reviewed. We calculated changes in demographics, comorbidities, and adverse events (AEs) over time. Risk factors for AEs were also assessed. Results Between 2010 and 2017, there was an increased prevalence of obesity (35.1% to 57.6%), tobacco smoking (12.5% to 17.8%), and renal disease (5.2% to 8.9%). There were reductions in coronary artery disease (17.3% to 13.4%) and chronic warfarin use (6.7% to 3.1%). Inpatient AEs decreased from 4.9% to 2.5%, (P < .01), primarily driven by reductions in anticoagulant-associated AEs, including major bleeding and hematomas (from 2.8% to 1.0%, P < .001), catheter-associated urinary tract infections (1.1% to 0.2%, P < .001), pressure ulcers (0.8% to 0.2%, P < .001), and venous thromboembolism (0.3% to 0.1%, P = .04). The adjusted annual decline in the risk of developing any in-hospital AE was 14% (95% confidence interval [CI] 10%-17%). Factors associated with developing an AE were advanced age (odds ratio [OR] = 1.01, 95% CI 1.00-1.01), male sex (OR = 1.21, 95% CI 1.02-1.44), coronary artery disease (OR = 1.35, 95% CI 1.07-1.70), heart failure (OR = 1.70, 95% CI 1.20-2.41), and renal disease (OR = 1.71, 95% CI 1.23-2.37). Conclusions Despite increasing prevalence of obesity, tobacco smoking, and renal disease, inpatient AEs after primary TKA have decreased over the past several years. This improvement is despite the increasing complexity of the inpatient TKA population over time.
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Peach BC, Li Y, Cimiotti JP. Urosepsis in Older Adults: Epidemiologic Trends in Florida. J Aging Soc Policy 2021; 34:626-640. [PMID: 33413039 DOI: 10.1080/08959420.2020.1851432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The incidence and geographic distribution of urosepsis, a life-threatening condition in older adults, is not well understood. The Florida State Inpatient Databases (2012-2014) showed an increase in the incidence of community-acquired urosepsis (5.37 to 6.16 per 1000), particularly among Hispanic older adults residing in low socioeconomic, urban areas with large numbers of nursing homes. These findings suggest a state policy is needed to address community-based preventative care and education for early detection of urosepsis in low-income urban areas. It is important for local health departments to partner with nursing homes to address disparities in care that disproportionally impact Hispanics.
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Affiliation(s)
- Brian C Peach
- College of Nursing, University of Central Florida, Orlando, FL, USA
| | - Yin Li
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | - Jeannie P Cimiotti
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Wang Y, Eldridge N, Metersky ML, Sonnenfeld N, Rodrick D, Fine JM, Eckenrode S, Galusha DH, Tasimi A, Hunt DR, Bernheim SM, Normand SLT, Krumholz HM. Association Between Medicare Expenditures and Adverse Events for Patients With Acute Myocardial Infarction, Heart Failure, or Pneumonia in the United States. JAMA Netw Open 2020; 3:e202142. [PMID: 32259263 PMCID: PMC7139276 DOI: 10.1001/jamanetworkopen.2020.2142] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
IMPORTANCE Studies have shown that adverse events are associated with increasing inpatient care expenditures, but contemporary data on the association between expenditures and adverse events beyond inpatient care are limited. OBJECTIVE To evaluate whether hospital-specific adverse event rates are associated with hospital-specific risk-standardized 30-day episode-of-care Medicare expenditures for fee-for-service patients discharged with acute myocardial infarction (AMI), heart failure (HF), or pneumonia. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used the 2011 to 2016 hospital-specific risk-standardized 30-day episode-of-care expenditure data from the Centers for Medicare & Medicaid Services and medical record-abstracted in-hospital adverse event data from the Medicare Patient Safety Monitoring System. The setting was acute care hospitals treating at least 25 Medicare fee-for-service patients for AMI, HF, or pneumonia in the United States. Participants were Medicare fee-for-service patients 65 years or older hospitalized for AMI, HF, or pneumonia included in the Medicare Patient Safety Monitoring System in 2011 to 2016. The dates of analysis were July 16, 2017, to May 21, 2018. MAIN OUTCOMES AND MEASURES Hospitals' risk-standardized 30-day episode-of-care expenditures and the rate of occurrence of adverse events for which patients were at risk. RESULTS The final study sample from 2194 unique hospitals included 44 807 patients (26.1% AMI, 35.6% HF, and 38.3% pneumonia) with a mean (SD) age of 79.4 (8.6) years, and 52.0% were women. The patients represented 84 766 exposures for AMI, 96 917 exposures for HF, and 109 641 exposures for pneumonia. Patient characteristics varied by condition but not by expenditure category. The mean (SD) risk-standardized expenditures were $22 985 ($1579) for AMI, $16 020 ($1416) for HF, and $16 355 ($1995) for pneumonia per hospitalization. The mean risk-standardized rates of occurrence of adverse events for which patients were at risk were 3.5% (95% CI, 3.4%-3.6%) for AMI, 2.5% (95% CI, 2.5%-2.5%) for HF, and 3.0% (95% CI, 2.9%-3.0%) for pneumonia. An increase by 1 percentage point in the rate of occurrence of adverse events was associated with an increase in risk-standardized expenditures of $103 (95% CI, $57-$150) for AMI, $100 (95% CI, $29-$172) for HF, and $152 (95% CI, $73-$232) for pneumonia per discharge. CONCLUSIONS AND RELEVANCE Hospitals with high adverse event rates were more likely to have high 30-day episode-of-care Medicare expenditures for patients discharged with AMI, HF, or pneumonia.
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Affiliation(s)
- Yun Wang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Noel Eldridge
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Washington, DC
| | - Mark L. Metersky
- Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Connecticut School of Medicine, Farmington
| | - Nancy Sonnenfeld
- Centers for Medicare & Medicaid Services, Department of Health and Human Services, Washington, DC
| | - David Rodrick
- Agency for Healthcare Research and Quality, Department of Health and Human Services, Washington, DC
| | - Jonathan M. Fine
- Asthma, Pulmonary and Critical Medicine, Norwalk Hospital, Norwalk, Connecticut
| | | | - Deron H. Galusha
- General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - David R. Hunt
- Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, Washington, DC
| | - Susannah M. Bernheim
- General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Sharon-Lise T. Normand
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Harlan M. Krumholz
- General Internal Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
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Ladhani HA, Tseng ES, Claridge JA, Towe CW, Ho VP. Catheter-Associated Urinary Tract Infections among Trauma Patients: Poor Quality of Care or Marker of Effective Rescue? Surg Infect (Larchmt) 2020; 21:752-759. [PMID: 32212990 DOI: 10.1089/sur.2019.211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Catheter-associated urinary tract infection (CAUTI) is associated generally with worse outcomes among hospitalized patients, but the impact of CAUTI on clinical outcomes is poorly described in trauma patients. We hypothesized that trauma patients with CAUTI would have worse outcomes such as longer length of stay (LOS), fewer discharges to home, and higher outcome of death. Methods: Patients with LOS >2 d in the 2016 Trauma Quality Improvement Program (TQIP) database were included. Patients with and without CAUTI were matched 1:1 via a propensity score using patient, injury, and hospital factors as covariates. Matched pair analysis was performed to compare difference in clinical outcomes between patients with and without CAUTI. Results: There were 238,274 patients identified, of whom 0.7% had a diagnosis of CAUTI. Prior to matching, CAUTI patients had a higher mortality rate (6.6% vs. 3.4%, p < 0.01), but groups differed significantly. There were 1,492 matched pairs created, with effective reduction in bias; post-match propensity score covariates all had absolute standardized differences <0.1. In matched pair analysis, CAUTI patients had lower outcome of death compared with patients without CAUTI (6.7% vs. 10.1%, p < 0.01). The CAUTI was associated with longer length of stay, more intensive care unit and ventilator days, more unplanned events, and fewer discharges to home (all p < 0.01). Conclusions: Trauma patients with CAUTI had lower outcome of death compared with patients without CAUTI, despite worse clinical outcomes in all other aspects. This difference may be associated with "rescue" care in the form of unplanned events, and CAUTI may be an unintended consequence of this "rescue" care, rather than a marker of poor quality of care.
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Affiliation(s)
- Husayn A Ladhani
- Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Esther S Tseng
- Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jeffrey A Claridge
- Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Christopher W Towe
- Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Vanessa P Ho
- Department of Surgery, MetroHealth Medical Center, Cleveland, Ohio, USA.,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Division of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
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Barnum T, Tatebe LC, Halverson AL, Helenowski IB, Yang AD, Odell DD. Outcomes Associated With Insertion of Indwelling Urinary Catheters by Medical Students in the Operating Room Following Implementation of a Simulation-Based Curriculum. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:435-441. [PMID: 31651436 PMCID: PMC7382914 DOI: 10.1097/acm.0000000000003052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
PURPOSE Catheter-associated urinary tract infection (CAUTI) is a priority quality metric for hospitals. The impact of placement of indwelling urinary catheter (IUC) by medical students on CAUTI rates is not well known. This study examined the impact of a simulation-based medical student education curriculum on CAUTI rates at an academic medical center. METHOD Patient characteristics, procedural data, and outcome data from all operating room IUC insertions from June 2011 through December 2016 at the Northwestern University Feinberg School of Medicine were analyzed using a multivariable model to evaluate associations between CAUTI and inserting provider. Infection data before and after implementation of a simulation-based IUC competency course for medical students were compared. RESULTS A total of 57,328 IUC insertions were recorded during the study period. Medical students inserted 12.6% (7,239) of IUCs. Medical students had the lowest overall rate of CAUTI among all providers during the study period (medical students: 0.05%, resident/fellows: 0.2%, attending physicians: 0.3%, advanced practice clinicians: 0.1%, nurses: 0.2%; P = .003). Further, medical student IUC placement was not associated with increased odds of CAUTI in multivariable analysis (odds ratio, 0.411; 95% confidence interval: 0.122, 1.382; P = .15). Implementation of a simulation-based curriculum for IUC insertion resulted in complete elimination of CAUTI in patients catheterized by medical students (0 in 3,471). CONCLUSIONS IUC insertion can be safely performed by medical students in the operating room. Simulation-based skills curricula for medical students can be effectively implemented and achieve clinically relevant improvements in patient outcomes.
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Affiliation(s)
- Trevor Barnum
- T. Barnum is surgical nurse educator, Department of Surgical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0001-9709-3810. L.C. Tatebe is adjunct assistant professor of surgery, Division of Trauma and Critical Care Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, and trauma, critical care, and general surgeon, Advocate Good Samaritan Hospital, Downers Grove, Illinois; ORCID: https://orcid.org/0000-0003-0401-3813. A.L. Halverson is professor of surgery, Division of Gastrointestinal Surgery, vice chair for education, and faculty, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: https://orcid.org/0000-0003-1040-4183. I.B. Helenowski is statistician, Department of Preventative Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. A.D. Yang is associate professor, Division of Surgical Oncology, and faculty, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois. D.D. Odell is associate professor, Division of Thoracic Surgery, and faculty, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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10
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Meddings J, Manojlovich M, Fowler KE, Ameling JM, Greene L, Collier S, Bhatt J, Saint S. A Tiered Approach for Preventing Catheter-Associated Urinary Tract Infection. Ann Intern Med 2019; 171:S30-S37. [PMID: 31569226 DOI: 10.7326/m18-3471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jennifer Meddings
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., S.S.)
| | | | - Karen E Fowler
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (K.E.F.)
| | | | - Linda Greene
- University of Rochester Highland Hospital, Rochester, New York (L.G.)
| | - Sue Collier
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., J.B.)
| | - Jay Bhatt
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (S.C., J.B.)
| | - Sanjay Saint
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (J.M., S.S.)
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Abstract
Catheter-associated urinary tract infection remains one of the most prevalent, yet preventable, health care-associated infections. General prevention strategies include strict adherence to hand hygiene and antimicrobial stewardship. Duration of urinary catheterization is the most important modifiable risk factor. Targeted prevention strategies include limiting urinary catheter use; physician reminder systems, nurse-initiated discontinuation protocols, and automatic stop orders have successfully decreased catheter duration. Alternatives should be considered. If catheterization is necessary, proper aseptic practices for insertion and maintenance and closed catheter collection systems are essential for prevention. The use of bladder bundles and collaboratives aids in the effective implementation of prevention measures.
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Affiliation(s)
- Emily K Shuman
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, F4007 University Hospital South, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5226, USA; Department of Infection Prevention and Epidemiology, Michigan Medicine, 300 North Ingalls Building 8B06, Ann Abror, MI 48109-5479, USA.
| | - Carol E Chenoweth
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, F4007 University Hospital South, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5226, USA; Antimicrobial Stewardship Program, Michigan Medicine, F4141 University Hospital South, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5226, USA
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Factors Associated With Healthcare-Acquired Catheter-Associated Urinary Tract Infections: Analysis Using Multiple Data Sources and Data Mining Techniques. J Wound Ostomy Continence Nurs 2018. [PMID: 29521928 DOI: 10.1097/won.0000000000000409] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to identify factors associated with healthcare-acquired catheter-associated urinary tract infections (HA-CAUTIs) using multiple data sources and data mining techniques. SUBJECTS AND SETTING Three data sets were integrated for analysis: electronic health record data from a university hospital in the Midwestern United States was combined with staffing and environmental data from the hospital's National Database of Nursing Quality Indicators and a list of patients with HA-CAUTIs. METHODS Three data mining techniques were used for identification of factors associated with HA-CAUTI: decision trees, logistic regression, and support vector machines. RESULTS Fewer total nursing hours per patient-day, lower percentage of direct care RNs with specialty nursing certification, higher percentage of direct care RNs with associate's degree in nursing, and higher percentage of direct care RNs with BSN, MSN, or doctoral degree are associated with HA-CAUTI occurrence. The results also support the association of the following factors with HA-CAUTI identified by previous studies: female gender; older age (>50 years); longer length of stay; severe underlying disease; glucose lab results (>200 mg/dL); longer use of the catheter; and RN staffing. CONCLUSIONS Additional findings from this study demonstrated that the presence of more nurses with specialty nursing certifications can reduce HA-CAUTI occurrence. While there may be valid reasons for leaving in a urinary catheter, findings show that having a catheter in for more than 48 hours contributes to HA-CAUTI occurrence. Finally, the findings suggest that more nursing hours per patient-day are related to better patient outcomes.
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Fenner A. Proceed with CAUTIon. Nat Rev Urol 2017; 14:517. [DOI: 10.1038/nrurol.2017.105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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