Urinary Catheter Use and Appropriateness in U.S. Emergency Departments, 1995–2010

<jats:title>Abstract</jats:title><jats:sec><jats:title>Objectives</jats:title><jats:p>Catheter‐associated urinary tract infection (<jats:styled-content style="fixed-case">CAUTI</jats:styled-content>) is the most prevalent hospital‐acquired infection, yet little is known about emergency department (<jats:styled-content style="fixed-case">ED</jats:styled-content>) use of urinary catheters. The objective was to describe use of urinary catheters in U.S. <jats:styled-content style="fixed-case">ED</jats:styled-content>s and determine the proportion that was potentially avoidable.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>The National Hospital Ambulatory Medical Care Survey (<jats:styled-content style="fixed-case">NHAMCS</jats:styled-content>), a weighted probability sample of U.S. <jats:styled-content style="fixed-case">ED</jats:styled-content> visits, was analyzed from 1995 through 2010 for use of urinary catheters in adults. Use of a urinary catheter was a specific chart review element and was classified as potentially avoidable if none of the Centers for Disease Control and Prevention (<jats:styled-content style="fixed-case">CDC</jats:styled-content>) list of appropriate indications were met by <jats:styled-content style="fixed-case">ED</jats:styled-content> visit diagnoses or patient disposition. Annual frequency of urinary catheter use and appropriateness were calculated. Predictors of <jats:styled-content style="fixed-case">ED</jats:styled-content>‐placed urinary catheters for admitted patients were assessed with multivariate logistic regression.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>The annual rate of <jats:styled-content style="fixed-case">ED</jats:styled-content>‐placed urinary catheters varied from 2.2 to 3.3 per 100 adult <jats:styled-content style="fixed-case">ED</jats:styled-content> visits. Among admitted patients, 8.5% (95% confidence interval [<jats:styled-content style="fixed-case">CI</jats:styled-content>] = 8.0% to 9.1%) received urinary catheters; 64.9% (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> = 56.9% to 72.9%) were potentially avoidable. Among discharged patients 1.6% (95% <jats:styled-content style="fixed-case">CI</jats:styled-content> = 1.5% to 1.7%) received urinary catheters. There was no significant trend over time in the use of urinary catheters or potentially avoidable urinary catheters (<jats:styled-content style="fixed-case">PAUC</jats:styled-content>s). Predictors of catheter use in admitted patients included indicators of patient severity, female sex, and race/ethnicity. Hospital characteristics predicting catheter use included region, ownership type, and urban location. Predictors of potentially avoidable urinary catheter use were lower patient severity, female sex, care by a midlevel practitioner, and nonurban location.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Reducing use of urinary catheters outside of <jats:styled-content style="fixed-case">CDC</jats:styled-content> guideline criteria in <jats:styled-content style="fixed-case">ED</jats:styled-content> patients is a promising strategy to reduce <jats:styled-content style="fixed-case">CAUTI</jats:styled-content>s.</jats:p></jats:sec>