Department of Urology, University of Michigan, Ann Arbor.
VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
JAMA Netw Open. 2024 Jul 1;7(7):e2422281. doi: 10.1001/jamanetworkopen.2024.22281.
Acute urinary retention (UR) is common, yet variations in diagnosis and management can lead to inappropriate catheterization and harm.
To develop an algorithm for screening and management of UR among adult inpatients.
DESIGN, SETTING, AND PARTICIPANTS: In this mixed-methods study using the RAND/UCLA Appropriateness Method and qualitative interviews, an 11-member multidisciplinary expert panel of nurses and physicians from across the US used a formal multi-round process from March to May 2015 to rate 107 clinical scenarios involving diagnosis and management of adult UR in postoperative and medical inpatients. The panel ratings informed the first algorithm draft. Semistructured interviews were conducted from October 2020 to May 2021 with 33 frontline clinicians-nurses and surgeons from 5 Michigan hospitals-to gather feedback and inform algorithm refinements.
Panelists categorized scenarios assessing when to use bladder scanners, catheterization at various scanned bladder volumes, and choice of catheterization modalities as appropriate, inappropriate, or uncertain. Next, qualitative methods were used to understand the perceived need, usability, and potential algorithm uses.
The 11-member expert panel (10 men and 1 woman) used the RAND/UCLA Appropriateness Method to develop a UR algorithm including the following: (1) bladder scanners were preferred over catheterization for UR diagnosis in symptomatic patients or starting as soon as 3 hours since last void if asymptomatic, (2) bladder scanner volumes appropriate to prompt catheterization were 300 mL or greater in symptomatic patients and 500 mL or greater in asymptomatic patients, and (3) intermittent was preferred to indwelling catheterization for managing lower bladder volumes. Interview findings were organized into 3 domains (perceived need, feedback on algorithm, and implementation suggestions). The 33 frontline clinicians (9 men and 24 women) who reviewed the algorithm reported that an evidence-based protocol (1) was needed and could be helpful to clinicians, (2) should be simple and graphically appealing to improve rapid clinician review, and (3) should be integrated within the electronic medical record and prominently displayed in hospital units to increase awareness. The draft algorithm was iteratively refined based on stakeholder feedback.
In this study using a systematic, multidisciplinary, evidence- and expert opinion-based approach, a UR evaluation and catheterization algorithm was developed to improve patient safety by increasing appropriate use of bladder scanners and catheterization. This algorithm addresses the need for practical guidance to manage UR among adult inpatients.
急性尿潴留（UR）很常见，但诊断和管理方面的差异可能导致不适当的导尿和伤害。
为成年住院患者的 UR 筛查和管理制定一个算法。
设计、地点和参与者：在这项使用 RAND/UCLA 适宜性方法和定性访谈的混合方法研究中，来自美国各地的 11 名护士和医生组成的多学科专家小组使用正式的多轮流程，于 2015 年 3 月至 5 月对涉及术后和内科住院患者的成人 UR 诊断和管理的 107 个临床情况进行了评分。小组的评分结果为第一个算法草案提供了信息。2020 年 10 月至 2021 年 5 月，对来自密歇根州 5 家医院的 33 名一线临床医生（护士和外科医生）进行了半结构化访谈，以收集反馈意见并改进算法。
小组成员对评估何时使用膀胱扫描仪、在各种扫描膀胱容量下进行导尿以及选择导尿方式的情况进行了分类，将其归类为适当、不适当或不确定。接下来，使用定性方法来了解感知需求、可用性和潜在的算法用途。
由 11 名专家组成的小组（10 名男性和 1 名女性）使用 RAND/UCLA 适宜性方法制定了一个 UR 算法，包括以下内容：（1）如果有症状，膀胱扫描仪优于导尿术，无症状者应在最后一次排尿后 3 小时内开始使用；（2）有症状患者的合适膀胱扫描量为 300 毫升或以上，无症状患者为 500 毫升或以上；（3）对于较低的膀胱容量，间歇性导尿优于留置导尿。访谈结果分为 3 个领域（感知需求、对算法的反馈和实施建议）。审查该算法的 33 名一线临床医生（9 名男性和 24 名女性）报告说，需要一个基于证据的方案（1）可以帮助临床医生；（2）应简单并具有吸引力，以提高临床医生的快速审查；（3）应整合到电子病历中，并在医院病房中突出显示，以提高认识。根据利益相关者的反馈，对草案算法进行了迭代细化。
在这项使用系统的、多学科的、基于证据和专家意见的方法的研究中，制定了 UR 评估和导尿算法，通过增加对膀胱扫描仪和导尿术的适当使用，提高患者安全性。该算法满足了管理成年住院患者 UR 的实际指导需求。
