Abstract
BackgroundUrinary catheters are a common medical intervention, yet they can also be associated with harmful adverse events such as infection, urinary tract trauma, delirium and patient discomfort. The purpose of this study was to describe the use of the SafetyLEAP program to drive improvement efforts, and specifically to reduce the use of urinary catheters on general internal medicine wards.MethodsA pre and post intervention study using the SafetyLEAP program was performed with urinary catheter prevalence as the primary outcome on two general internal medicine wards in a large academic health sciences center.ResultsA total of n = 534 patients (n = 283 from ward #1; and n = 252 from ward #2) were included in the initial audit and feedback portion of the study and 1601 patients (n = 824 pre-intervention and n = 777 post-intervention were included in the planned quality improvement portion of the study). A total of 379 patients during the quality improvement intervention had a urinary catheter. Overall, the adherence to the SafetyLEAP program was 97.4% on both general internal medicine wards. The daily catheter point prevalence decreased from 22 to 13%. After the implementation of the program, the urinary catheter utilization ratio (defined as urinary catheter days/patient days) declined from 0.14 to 0.12. Catheter-associated urinary tract infections (CAUTI) were unchanged.ConclusionThe SafetyLEAP program can help provide a systematic approach to the detection, and reduction of safety incidents. Future studies should aim at refining and implementing this intervention broadly.
Highlights
Urinary catheters are a common medical intervention; they can be associated with harmful adverse events such as infection, urinary tract trauma, delirium and patient discomfort
The program consists of three components that together make up the acronym LEAP: 1) Leadership and Engagement, 2) Audit and feedback, and 3) Planned quality improvement intervention
The purpose of this study was to describe the use of the SafetyLEAP program to drive improvement efforts, and to reduce the prevalence of urinary catheters at a large academic health center
Summary
Urinary catheters are a common medical intervention, yet they can be associated with harmful adverse events such as infection, urinary tract trauma, delirium and patient discomfort. The purpose of this study was to describe the use of the SafetyLEAP program to drive improvement efforts, and to reduce the use of urinary catheters on general internal medicine wards. Our institution identified urinary catheters as a patient safety issue during the implementation of the audit and feedback component of the SafetyLEAP program on our general internal medicine (GIM) wards. The program consists of three components that together make up the acronym LEAP: 1) Leadership and Engagement, 2) Audit and feedback, and 3) Planned quality improvement intervention. Audit and feedback (or prospective surveillance) is a method used to systematically identify adverse events, which may be more accurate and timely than other methods of adverse event detection [5,6,7,8]. Many organizations are still struggling to quantitatively show significant improvements in safety, the use of the SafetyLEAP program to more accurately measure safety is a promising approach
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