Society of Hospital Medicine – Adult Hospital Medicine
View all recommendations from this societyReleased February 21, 2013; Updated October 18, 2021
Don’t place, or leave in place, urinary catheters for incontinence or convenience or monitoring of output for non-critically ill patients (acceptable indications: critical illness, obstruction, hospice, perioperatively (if required) for <2 days or for urologic/pelvic procedures; use weights instead to monitor diuresis).
Catheter Associated Urinary Tract Infections (CAUTIs) are the most frequently occurring health care acquired infection (HAI). Use of urinary catheters for incontinence or convenience without proper indication or specified optimal duration of use increases the likelihood of infection and is commonly associated with greater morbidity, mortality and health care costs. Published guidelines suggest that hospitals and long-term care facilities should develop, maintain and promulgate policies and procedures for recommended catheter insertion indications, insertion and maintenance techniques, discontinuation strategies and replacement indications.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
How The List Was Created
(1–5)
The Society of Hospital Medicine (SHM) created a Choosing Wisely® subcommittee comprised of representatives of the Hospital Quality and Patient Safety committee and included diverse representation of academic, community and adult hospitalists. SHM committee members submitted 150 recommendations for consideration, which were discussed for frequency of occurrence, the uniqueness of the tests and treatments and whether the cost burden for a specific test or treatment proved to be significant, narrowing the list to 65 items. The Choosing Wisely subcommittee ranked these items and a survey was sent to all SHM members to arrive at 11 recommendations, of which the final five were determined utilizing the Delphi method. SHM’s Board approved the final recommendations.
(6–11)
These recommendations were created by the SHM Hospital Quality and Patient Safety Committee’s High Value Care Sub-Committee (HVCC).
Phase 1: Crowdsourcing and Brainstorming – An online questionnaire requesting examples of low-value care in adult hospital medicine was sent to the SHM listserv, along with ABIM Foundation and affiliated social media outlets. All examples of low-value care from the questionnaire were compiled, edited, counted, and categorized into 5 domains: laboratory, imaging, medication, diagnostics and other. Duplicate or similar recommendations were also taken into account. Recommendations in the previous SHM CW Top 5 list were removed. All items with 10 or more mentions were taken into the next phase in an effort to capture the most prominent themes.
Phase 2: Literature Search and Developing Recommendations – All items brought into this phase were individually reviewed and discussed through an iterative process. Items were divided among HVCC members, and a literature search was performed in the PubMed database. Focused recommendations were developed and presented to the committee for review. Items that were duplicative or had insufficient evidence to support the recommendation were removed, leaving 22 items.
Phase 3: Modified Delphi Voting – For the remaining recommendations, a Delphi scoring process was utilized to reach consensus among clinicians and patient advocates. A total of 7 HVCC members and 7 patient advocates voted on the recommendations.
For each recommendation on the voting survey, clinician respondents were asked to rate on a 1-5 Likert scale on three criteria: (1) strength of evidence, (2) potential for avoiding patient harm, and (3) relevance to hospital medicine. Patient advocates were asked to rate each recommendation based on the same Likert scale on a slightly different criteria: (1) strength of evidence, (2) potential for avoiding patient harm, and (3) relevance to patients.
SHM’s disclosure and conflict of interest policy can be found at www.hospitalmedicine.org/industry.
Sources
Hooton TM, Bradley SF, Cardena DD, Colgan R, Geerlings SR, Rice JC, Saint S, Schaeffer AJ, Tambayh PA, Tenke P, Nicolle LE. Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America Clin Infect Dis [Internet]. 2010 [cited 2012 Sep 4];50(5):625-663.
Saint S, Meddings JA, Calfee D, Kowalski CP, Krien SL. Catheter-associated Urinary Tract Infection and the Medicare Rule Changes. Ann Intern Med [Internet]. 2009 Jun 16 [cited 2012 Sep 4];150(12):877–884.
Centers for Medicare & Medicaid Services, Joint Commission. Standards for hospital care, surgical care improvement project (SCIP), SCIP-Inf-9; Performance Measure Name: Urinary catheter removed on Postoperative Day 1 (POD 1) or Postoperative Day 2 (POD 2) with day of surgery being day zero. 2013. 2013 Joint Commission National Hospital Inpatient Quality Measures Specification Manual, version 4.11.
