STATEMENT OF WORK This project is a multi-disciplinary collaboration within the Institute for Healthcare Policy and Innovation (IHPI) of investigators from the Departments of Internal Medicine, Surgery, and Urology at the University of Michigan and the Ann Arbor VA Medical Center, to improve the measurement and safety of perioperative urinary catheter use, by reducing catheter use and catheter complications and improving postoperative urinary retention management. This project is focused on adults undergoing very common general surgical procedures: appendectomy, cholecystectomy, colorectal surgery, and hernia repairs. This project leverages our IHPI investigators? clinical and research expertise understanding urinary catheter indications and complications, performing focus groups, site visits, and chart abstraction, and developing, implementing, and evaluating interventions to reduce urinary catheter use and harm, as well as experience working with the Michigan Surgical Quality Collaborative (MSQC). This project will develop and pilot new measures of perioperative urinary catheter use, postoperative urinary retention, and urinary catheter-associated complications. The toolkit intervention will address clinician knowledge and urinary catheterization skills, as well as communication and implementation challenges anticipated to impact catheter use in different types of perioperative clinical settings. This intervention aims to reduce perioperative urinary catheter use, catheter- associated complications including infections and catheter-associated trauma, and improve management of postoperative urinary retention. This toolkit will be developed, implemented, and evaluated in collaboration with a pilot group of MSQC hospitals? surgeons and nurses.
Our study focuses on improving measurement as well as prevention of complications that patients experience related to routinely placed tubes called urinary catheters to empty the bladder during and after surgery; urinary catheters are among the most commonly used medical devices in the world with an estimated 100 million indwelling catheters sold annually worldwide and one-quarter million sold in the United States, but urinary catheters? risks have not been well studied. Although infections related to urinary catheters are getting more attention recently due to Medicare-required public reporting and hospital penalties, there is less recognition that non- infectious complications related to the trauma of catheter placement and removal are as common as urinary tract infections ? and often have long-lasting consequences for patients with abnormal bladder emptying and discomfort. This study is being performed to develop better tools to measure and reduce perioperative urinary catheter use, as well as related post- operative urinary retention and urinary catheter complications.
