A Mixed Methods Evaluation of an Electronic Reminder System for Reducing Urinary Catheter Use in Australian Hospital

Abstract

Introduction: An important risk-factor for catheter-associated urinary tract infections (CAUTIs) is prolonged catheterisation. This study examined the efficacy of an electronic reminder system to reduce catheterisation duration and its effect on nurses’ ability to deliver patient care. Methods: A stepped-wedge randomised controlled design, in addition to a survey and focus groups were undertaken. The intervention was the use of the CATH TAG, an electronic tag placed on the catheter bag, which prompted a review of ongoing catheterisation. The study was conducted in an Australian hospital, over 24 weeks. Primary outcomes were mean catheter duration and perceptions of nurses about ease of use. A Cox proportional hazards regression model was used, duration was the outcome variable. Patients who were transferred between wards with catheters were censored. The intervention was treated as a time varying covariate. Results: 1167 patients participated in the study. The duration of catheterisation was slightly lower in patients where the CATH TAG was used (mean 5.1 vs 5.5 days, HR 1.02 95% CI: 0.91, 1.14, p=0.75). Excluding the patients transferred between wards, mean catheterisation duration was 5.5 vs 4.2 days, IRR 0.78 (22% reduction), p=0.15. Data gathered from the focus group and the online survey for nurses, indicated positive response. Conclusion: A clinically important reduction in catheter duration for a sub-group of patients was identified. The short duration of this study may have impeded the ability to change catheter practice and hence duration in the short term.