Algorithm designed to help prevent catheterization-associated injury

In this video, Jennifer Ann Meddings, MD, shares the take-home message from the JAMA Network Open paper “Urinary Retention Evaluation and Catheterization Algorithm for Adult Inpatients.” Meddings is an associate professor at the University of Michigan in Ann Arbor. The algorithm can be accessed at: https://msqc.org/wp-content/uploads/2024/01/Urinary-retention-and-safe-catheter-insertion_2024-version.pdf

Transcription:

What is the take-home message for the practicing urologist?

I actually worked with several different urologists while we were developing this. Some were academic urologists that were in large practices. Others were practicing with a community where there was maybe only 1 or 2 that worked with that hospital. I think it's important for urologists to know that there was a large, large need for these. This algorithm is certainly not meant to replace the expertise that the urologists are bringing; this was actually developed with input by our urologists, and we're really trying to prevent a lot of those injuries that urologists would need to repair later. It's important for urologists to be aware that some hospitals may be implementing these types of algorithms and to let you know it was evidence based. And this is not intended for the urology patient. This is not replacing your postoperative instructions for those patients and we're very clear about that.

One thing we do think it's important to know is that some of our nurses have told us that when patients have had urology procedures or have had a urology history, and they get admitted, most of the time when they're getting issues with their catheter, they're not admitted to the urology service. They're admitted to a medical service, or they're admitted to a surgical service for another reason, like some type of infection, and they are less familiar with how to read, in the urology records, what is the preferred type of catheter for this patient? Are there any restrictions on catheterizing this patient, and so we really strongly encourage urologists to make it very easy to read if those patients have particular catheter needs or should never be catheterized by a nonurologist. The other thing to know is that a strategy that we're using in our collaborative that they might think about is when we've had patients who have a difficult catheterization, we're actually giving them a card that says "This patient has had challenges with catheterization. This is what was needed to catheterize them," such as, they needed this type of catheter, or they needed to have a cystoscope or a urology consult to do this, because when that patient presents at the ER again, they can actually show that card. And the patients tend to be very invested in not having to get a catheter placed 6 times before it's successful. And so we're hoping that urologists might adopt something similar, because sometimes the patients are presenting at hospitals that aren't their regular hospital when it's an emergency. This is now becoming the standard for patients who have difficult airways, and we're hoping it will be the standard for other types of difficult device placements, such as a urinary catheter. And we actually have cards on this website if they're interested in using something like that for their own urology patients.

This transcription was edited for clarity.