Journal of General Internal Medicine

, Volume 23, Issue 6, pp 816–820

Stop Orders to Reduce Inappropriate Urinary Catheterization in Hospitalized Patients: A Randomized Controlled Trial

  • Mark Loeb
  • Derek Hunt
  • Kelly O’Halloran
  • Soo Chan Carusone
  • Nancy Dafoe
  • Stephen D. Walter
Original Article

Abstract

Background

Hospitalized patients frequently have urinary catheters inserted for inappropriate reasons. This can lead to urinary tract infections and other complications.

Objective

To assess whether stop orders for indwelling urinary catheters reduces the duration of inappropriate urinary catheterization and the incidence of urinary tract infections.

Design

A randomized controlled trial was conducted in three tertiary-care hospitals in Ontario, Canada. Patients with indwelling urinary catheters were randomized to prewritten orders for the removal of urinary catheters if specified criteria were not present or to usual care.

Participants

Six hundred ninety-two hospitalized patients admitted to hospital with indwelling urinary catheters inserted for ≤48 h.

Measurements

The main outcomes included days of inappropriate indwelling catheter use, total days of catheter use, frequency of urinary tract infection, and catheter reinsertions.

Results

There were fewer days of inappropriate and total urinary catheter use in the stop-order group than in the usual care group (difference −1.69 [95% CI −1.23 to −2.15], P < 0.001 and −1.34 days, [95% CI, −0.64 to −2.05 days], P < 0.001, respectively). Urinary tract infections occurred in 19.0% of the stop-order group and 20.2% of the usual care group, relative risk 0.94 (95% CI, 0.66 to 1.33), P = 0.71. Catheter reinsertion occurred in 8.6% of the stop-order group and 7.0% in the usual care group, relative risk 1.23 (95% CI, 0.72 to 2.11), P = 0.45.

Conclusions

Stop orders for urinary catheterization safely reduced duration of inappropriate urinary catheterization in hospitalized patients but did not reduce urinary tract infections.

KEY WORDS

urinary tract infections urinary catheters randomized controlled trial stop order 

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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Mark Loeb
    • 1
    • 2
    • 4
    • 5
  • Derek Hunt
    • 3
  • Kelly O’Halloran
    • 4
  • Soo Chan Carusone
    • 2
  • Nancy Dafoe
    • 1
  • Stephen D. Walter
    • 2
  1. 1.Department of Pathology and Molecular MedicineMcMaster UniversityHamiltonCanada
  2. 2.Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamiltonCanada
  3. 3.Department of MedicineMcMaster UniversityHamiltonCanada
  4. 4.Hamilton Health SciencesHamiltonCanada
  5. 5.McMaster UniversityHamiltonCanada

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