Quality improvement initiative to reduce inappropriate urinary catheterisation on a clinical teaching unit
Bibliographic record
Abstract
Indwelling urinary catheters are often inserted and retained without appropriate indications in the inpatient setting, leading to catheter-associated urinary tract infections (CAUTIs). Previous multidisciplinary toolkits have created modest reductions in inappropriate catheterisation, but these effects were not sustained. This study aimed to achieve a 50% reduction in catheter-days and CAUTIs per 100 patient-days in a general medicine ward at a Canadian tertiary care hospital.A preintervention evaluation of urinary catheterisation was completed by retrospective chart review from 2020 to 2022. A quality improvement initiative was then conducted using an interrupted time series design. Patients admitted during the study period to general internal medicine on the pilot ward with an indwelling urinary catheter were included.A physician-targeted intervention in the electronic medical record system triggered reminders for patients with catheters inserted for more than 24 hours. The second intervention implemented standardised discussion of catheterised patients in daily multidisciplinary rounds. Finally, a chronic catheter order was created for patients with chronic indwelling catheters.Our outcome measures were the number of catheter-days and CAUTIs per 100 patient-days. Process measures were the utilisation of electronic reminder features and implementation of catheter review during multidisciplinary rounds. The balancing measure was the frequency of urinary catheter reinsertion following a failed trial of void.Catheter-days per 100 patient-days decreased from 14.2 to 5.8 days postintervention. CAUTIs decreased from 0.47 to 0.31 CAUTI per 100 patient-days. On average, 80% of patients with catheters were reviewed monthly during multidisciplinary rounds. 24 patients required catheter reinsertion postintervention due to a failed trial of void.The implementation of a multifaceted approach on a general medicine ward consisting of physician reminders, standardised discussion of catheters in multidisciplinary rounds and chronic catheter orders was associated with a sustained reduction in catheter use and CAUTIs.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.018 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".