Expert discusses implementation of urinary retention evaluation algorithm

In this video, Jennifer Ann Meddings, MD, discusses the implementation of a urinary retention evaluation and catheterization algorithm that is described in the JAMA Network Open paper “Urinary Retention Evaluation and Catheterization Algorithm for Adult Inpatients.” The algorithm can be found by going to: https://msqc.org/wp-content/uploads/2024/01/Urinary-retention-and-safe-catheter-insertion_2024-version.pdf
Meddings is an associate professor at the University of Michigan in Ann Arbor.

Transcription:

The abstract mentions that the algorithm should be incorporated into the EMR. Could you discuss the potential challenges and strategies for successful implementation of the algorithm in various health care settings, particularly those with limited resources?

Most hospitals these days are using an EMR because it was required for Medicare years ago, but there are different levels of sophistication in the types of EMRs that people are using. The simplest way to try to integrate it is to simply give like a reference of where to find it, or a link to where you can get to the guideline in the order for urinary catheter or bladder scanner use. Other hospitals can do it a little bit more sophisticated. Say you want to do it for retention, they might even queue up, "are you doing it for symptomatic or asymptomatic?" and then actually have you document the bladder scan results. But most hospitals currently do not have that level of sophistication. And I don't think it's actually required for this to be used. What we think is really nice about it is it's not required to have it into an electronic medical record for this to work on the wards. Many of the hospitals that we're working with in our current collaborative actually, they have the algorithm. We have one that actually has more graphics...We actually worked with a graphic designer for the one that's actually used for the collaborative, and they actually laminate it and simply put it with a key ring on their bladder scanners. So that's like constant recurring just-in-time education [where] you're getting the bladder scanner out to see if they have retention, and then our algorithm is right there so that they don't have to find it. Because the other thing we learned in our interviews was that if they can't find the algorithm in their policy, folders on the network or something like that, it's never going to get used. And so we really strived to make it easy to read quickly, so that you wouldn't have to go to entire in service to figure out how to use it, and it would be right there. The low-tech solution is somehow attaching it to your bladder scanner. And often, what they will do is they'll put it on the handle. They'll put a big ring on the handle, and sometimes they put some other references there that they need anyway. So that was already part of the nursing workflow, and so we learned that from our qualitative interviews [that] that's an excellent way to try to implement this.

This transcription was edited for clarity.