Saint S, Wiese J, Amory J K, Bernstein M L, Patel U D, Zemencuk J K, Bernstein S J, Lipsky B A, Hofer T P
Department of Internal Medicine (SS, MLB, UDP, SJB, TPH), University of Michigan Medical School,;, Ann Arbor, Michigan, USA.
Am J Med. 2000 Oct 15;109(6):476-80. doi: 10.1016/s0002-9343(00)00531-3.
Although infections associated with indwelling urinary catheters are common, costly, and morbid, the use of these catheters is unnecessary in more than one-third of patients. We sought to assess whether attending physicians, medical residents, and medical students are aware if their hospitalized patients have an indwelling urinary catheter, and whether physician awareness is associated with appropriate use of these catheters.
The physicians and medical students responsible for patients admitted to the medical services at four university-affiliated hospitals were given a list of the patients on their service. For each patient, the provider was asked: "As of yesterday afternoon, did this patient have an indwelling urethral catheter?" Respondents' answers were compared with the results of examining the patient.
Among 288 physicians and students on 56 medical teams, 256 (89%) completed the survey. Of 469 patients, 117 (25%) had an indwelling catheter. There were a total of 319 provider-patient observations among these 117 patients. Overall, providers were unaware of catheterization for 88 (28%) of the 319 provider-patient observations. Unawareness rates by level of training were 21% for students, 22% for interns, 27% for residents, and 38% for attending physicians (P = 0.06). Catheter use was inappropriate in 36 (31%) of the 117 patients with a catheter. Providers were unaware of catheter use for 44 (41%) of the 108 provider-patient observations of patients who were inappropriately catheterized. Catheterization was more likely to be appropriate if respondents were aware of the catheter (odds ratio = 3.7; 95% confidence interval, 2.1 to 6.7, P <0.001).
Physicians are commonly unaware that their patients have an indwelling urinary catheter. Inappropriate catheters are more often "forgotten" than appropriate ones. System-wide interventions aimed at discontinuing unnecessary catheterization seem warranted.
尽管留置导尿管相关感染很常见，成本高昂且会引发疾病，但超过三分之一的患者使用这些导尿管是不必要的。我们试图评估主治医生、住院医师和医学生是否知晓其住院患者是否留置了导尿管，以及医生的知晓情况是否与这些导尿管的合理使用相关。
负责四所大学附属医院内科服务患者的医生和医学生收到了其负责患者的名单。对于每位患者，询问提供者：“截至昨天下午，该患者是否留置了尿道导尿管？”将受访者的答案与检查患者的结果进行比较。
在56个医疗团队的288名医生和学生中，256人（89%）完成了调查。在469名患者中，117人（25%）留置了导尿管。在这117名患者中，共有319次提供者 - 患者观察。总体而言，在319次提供者 - 患者观察中，有88次（28%）提供者不知道患者已插管。按培训水平划分的不知晓率分别为：学生21%，实习生22%，住院医师27%，主治医生38%（P = 0.06）。在117名留置导尿管的患者中，36人（31%）的导尿管使用不当。在108次对导尿管使用不当患者的提供者 - 患者观察中，有44次（41%）提供者不知道患者使用了导尿管。如果受访者知晓导尿管的存在，导尿管使用更可能是恰当的（优势比 = 3.7；95%置信区间，2.1至6.7，P <0.001）。
医生通常不知道其患者留置了导尿管。不合适的导尿管比合适的导尿管更常被“遗忘”。似乎有必要采取全系统的干预措施以停止不必要的导尿。
