James Hooten, MD – Kernoodle Clinic, Burlington, NC (Alamance Regional Medical Center)

The risk of catheter associated urinary tract infection increases with increasing duration of indwelling urinary catheterization. Surgical Care Improvement Project National Quality Measures include urinary catheter removal on postoperative day 1 or postoperative day 2 with the day of surgery being day zero. Compliance rate with this measure at Alamance Regional Medical Center has been monitored since the fourth quarter of 2009. Quarterly compliance rates have varied from 76% to 92% without any consistent improvement noted. In order to improve the compliance rates, review of “missed opportunities” will focus on the reasons why Foley catheters were not discontinued. Strategies will then be developed for improving the process whereby the target population can be identified by physicians and nurses, alerts for appropriate Foley management can be communicated, and supporting documentation for exceptions will be recorded.

Dr Hooten’s project deals with the important issue of urinary catheter management after surgery. The goal is to incorporate “best practices” on catheter management in his hospital. He has worked directly with physicians, nursing staff and others to improve the process. To date, the team has reviewed the catheter replacement pathway and identified wide variances of use within the hospital. The team will begin modifications in the next 1-2 months.

July 2011 Update

  • The numbers are good for the project and they are staying above the goal although not 100%.
  • All surgical specialties are now participating with N=30-50 per month and showing only 2-3 variances per month.
  • The automatic stops and nursing involvement is working very well.
  • The catheter-associated UTIs are grouped with the entire hospital. The team is trying to segregate the ortho/surgical patients.
  • The next step: Work with WI and OR to look at appropriate use of beta blockers peri-operatively. They have found that the inpatients were the patients not getting the beta blockers. Also, working with the QI department on a few projects to address later.
  • When asked what motivates him to continue with the QI projects, Dr. Hooten said, “Investment in terms of my care of the patients. Improving quality and decreasing complications is important. It benefits the patient and the system. It goes beyond one physician and one patient.”

NCPIQUE Quality Fellows presentation to NCMS Foundation Board of Trustees on October 21, 2011.