Impact of the lack of community urinary catheter care services on the Emergency Department

Abstract

ObjectivesTo conduct an audit of patients presenting with long-term urinary catheter (LTC)-associated problems to our Emergency Department (ED) and to assess the availability of community nursing support for their LTC. We also estimated the cost implication to the health service and the potential solutions to this issue, as although catheter care is provided by community nurses, LTC problems are common presentations to the ED and are often significant burdens to the services. Patients and MethodsA study was carried out of all patients presenting to the ED with a urinary catheter problem, specifically studying LTCs and the reason for presentation, district nurses' involvement, and the intervention received. ResultsIn all, 78 patients with a urinary catheter problem presented to the ED over a 69-day period, of whom 59 (68%) had a LTC. In all, 33 patients (42%) attended during normal working hours between 0900 and 1700 h. The mean (range) age was 74 (42-93) years and the duration the LTC had been in situ was 11 (1-120) months. The most common reasons for attendance were blocked catheter (37 patients, 47%) and catheter-bypass (18, 23%). Only 28 patients (36%) were known to district nursing services, and 14% were referred by a district nurse. Most of the remaining patients self-referred to the ED. No patient had any documented contact with their general practitioner. In addition, 64 patients (82%) had their catheter issues addressed adequately by ED nurses or doctors, without any urology involvement. ConclusionsThe high morbidity of LTCs causes a considerable demand on ED services, and has heavy cost implications to the health system. Most patients had minimal community nurse support, and their catheter problems were easily dealt with by ED nurses and doctors.

Supporting patients with long-term catheterisation to reduce risk of catheter-associated urinary tract infection

“…Catheter-related problems contribute to the financial burden on the NHS due to unscheduled visits to emergency services, patients' hospitalisation or delayed discharge from hospital, antimicrobial treatment and staff resources (Tay et al, 2016;Loveday et al, 2014). Although the robust economic assessments of the cost of catheter-related problems are not available, it has been estimated that treatment of CAUTI accounts for £99 million per year (approximately £1,968 per episode) (Loveday et al, 2014).…”

“…Although the robust economic assessments of the cost of catheter-related problems are not available, it has been estimated that treatment of CAUTI accounts for £99 million per year (approximately £1,968 per episode) (Loveday et al, 2014). Tay et al, (2016) indicated that 75% of patients who attended ED with catheter problems, could have been treated at home. This highlights the need to improve the quality of care and move towards a model that is based in the home to enable patients to self manage their catheter and reduce risk of CAUTI.…”

Urinary catheters: common urology problems in the community

“…At least 75% of the patients presenting to an emergency department with a catheter complication could have been manged in the community. 2 What should be done? In the caricature scenario described above, it is probably a bit late for communication with the hospital team that put the catheter in originally!…”

Managing long term indwelling urinary catheters

“…Problems with long term catheters, such as infections or blockage, affect individuals’ lives and healthcare resources, particularly out-of-hours services 3. This article aims to help healthcare professionals address the needs of any person living with or making the decision to have a long term indwelling urinary catheter (examples shown in fig 1).…”