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A Multidisciplinary Approach to Leveraging Data and Implementing Change: A Reduction in Emergency Department Foley Catheter Insertions

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      Background

      Foley catheter (FC) insertions in the Emergency Department (ED) create inherit infectious and non-infectious risks to patients due to the chaotic environment. Numerous FCs are placed in the ED due to convenience, lack of patient diagnosis and urgency. The objective of this study was to reduce the amount of FCs that are inserted in the ED, by utilizing a multidisciplinary team to implement practice changes based on real time data.

      Methods

      A cross-sectional study was performed from January 2018 – November 2019 in a Level I Trauma hospital. A multidisciplinary team including Infection Prevention (IP), Clinical Data Analytics and ED leadership developed a dashboard to determine FC insertions in the ED/1000 patients and common indications for Foley placement in the ED. Additionally, every FC that was placed in the ED was reviewed by IP and ED leadership for appropriateness. Any FC that were deemed inappropriate were then discussed with physicians and staff. Weekly and monthly reports were reviewed with ED leaders for trends. The number of FC insertions in the ED/1000 patient days in the pre-intervention period (January 2018 – December 2018) was compared to post-intervention (January 2019 – November 2019). A T-test was used to determine statistically significant change.

      Results

      A 22% reduction of FC insertions in the ED occurred between the pre- and post-intervention. During the pre-intervention period, the FC insertion rate was 11.62 FC insertions /1000 patients compared to 9.33 during the post intervention period (p < 0.01). The indication for Foley insertion was labeled as “other” decreased by 73.7% between pre- (19%) and post-intervention (5%) periods.

      Conclusions

      An engaged ED staff and clinical data analytics team were able to reduce risk to patients by decreasing FC insertions in the ED. Next steps will be to determine non-infectious poor outcomes to further reduce FC insertions in the ED.
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