At Sunnybrook Health Sciences Centre in Toronto, 18% of hospitalized patients were catheterized even though 69% lacked an appropriate guideline-based reason. Urinary catheter removal was frequently haphazard and many urinary catheters were re-inserted at the first sign of urinary retention. Consensus criteria for appropriate urinary catheter use was developed. A medical directive was developed to standardize removal of urinary catheters on transfer to the medicine ward. Staff were then trained to follow the medical directive to remove urinary catheters lacking pre-specified reasons and to follow a post-catheter care algorithm to detect and manage any urinary retention in a standard way. This approach has resulted in 50% fewer urinary catheters on the medical wards sustained beyond one year, and the team has not encountered any inappropriate urinary catheter removals.
The Lose the Tube toolkit contains the key ingredients of their approach.