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.

Introduction: Emergency department (ED) wait time is an important health system quality indicator. Prolonged consult to decision time (CTDT), the time it takes to reach a disposition decision after receiving a specialty consultation request, can contribute to increased overall length of stay in the ED. Objective: To identify delays in the consultation process for general internal medicine (GIM) and trial interventions to reduce CTDT. Methods: The study was conducted at a large tertiary teaching hospital with GIM inpatient wards at two campuses. Four interventions were trialed over sequential Plan-Do-Study-Act cycles: (1) process mapping, (2) resident education sessions, (3) audit and feedback of CTDT, and (4) adding a swing shift during peak consult volume. Measurements: The primary outcome measures were mean CTDT for patients admitted to GIM and the proportion of admitted patients with CTDT of less than 3 hours. Results: Mean CTDT decreased from 4.61 hours before intervention to 4.18 hours after intervention (p < .0001). The proportion of GIM patients with CTDT less than 3 hours increased from 25% to 33% (p < .0001). Conclusions: The interventions trialed led to a sustained reduction in CTDT over a 12-month period and demonstrated the effectiveness of education in influencing physician performance.

Aim To evaluate an intervention to reduce unnecessary urinary catheter use and prevent catheter‐associated urinary‐tract infections (CAUTI) in hospitalized patients across an academic health science centre. Methods We conducted a one‐group, pretest, posttest study with a theory‐based process evaluation. Phase 1 consisted of a pre/postintervention to test the impact of a CAUTI protocol. Audits on four units were conducted, and data were analysed descriptively. Phase 2 consisted of a theory‐based process evaluation to understand the barriers/enablers to the implementation. Semistructured interviews were conducted and then analysed using a systematic approach. Results In Phase 1, all inpatients with urinary catheters admitted to the units (N = 4) during the study period (N = 99, pre) and (N = 99, post) were included. CAUTI prevalence rate was 18.2% pre versus 14.1% post (p = .563). In Phase 2, participants (N = 18) who worked on the units were interviewed, and a total of 13 barriers and 19 enablers were found.

Background: Inappropriate use of urinary catheters can increase the risk of catheter-associated urinary tract infections (CAUTI) leading to increased morbidity and increased costs. The overall purpose of this study was to evaluate an intervention to reduce unnecessary urinary catheter use and prevent CAUTI in hospitalized patients across a large academic health science centre. Methods: This was a two-phase study, which took place between 2017 and 2019. Phase 1 was a pre- and post-intervention design to test the impact of a CAUTI protocol across the organization. Audits on 4 units pre and post were conducted, and data were analyzed descriptively. Phase 2 was a theory-based process evaluation to understand the barriers and enablers to the implementation. Semi-structured interviews were conducted and then analyzed using a systematic approach. Results: Phase 1: All inpatients with urinary catheters admitted on the four selected units during the study period (n=99, pre) and (n=99, post) were included. CAUTI prevalence rate was 18.2% pre vs 14.1% post (p=.563). Phase 2: participants (n=18) who worked during the study period on the four audit units were interviewed, and a total of 13 barriers and 19 enablers were found across the participant groups. Conclusion: No statistically significant difference in CAUTI prevalence rates were noted. The theory-based process evaluation provided insights into barriers and enablers to the implementation which may help reformulate the intervention in the future.