” A  finger or tube in every orifice” – Old School emergency medicine motto

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exit onlyIn my humble opinion foley catheters are the work of the devil.  Yes I know that in the right circumstances they are important in the care of patients and are a god send to those in acute urinary retention.

white spaceTrust me I know (See The Day I Almost Died…).  But everyone also knows many are placed for reasons that do not obviously benefit the patient. (perhaps up to half of those placed).

white spaceAnd to boot they cause infections.  Nasty multi-drug resistant infections. Close to 2,000 to 9,000 deaths per year are attributed to CAUTI (catheter associated urinary tract infections).

white spaceAnd, of course, there is a financial cost.  Estimates are $400M in 2007 dollars (http://www.cdc.gov/hai/pdfs/hai/scott_costpaper.pdf)


white spaceThe good news is that there is help out there to help us break our habit!


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This is a great initiative that is working on the state level to help emergency departments bring change to their systems and culture. ( OnTheCusp).  They give you all the tools you need to implement change and produce real results. We will be focusing on the inappropriate reasons that catheters get placed (particularly in the ER):

  • Incontinence (without additional indication)
  • Diuresis (think non-ICU CHF exacerbations)
  • Frequent, nonessential measurement of UOP
  • Nurse’s concern about patient comfort
  • Diarrhea (without additional indication)
  • Patient’s preference (without additional indication)


PatersonER will be participating in this initiative and looking forward to increasing the safety of our patients.  We will rely on the systems we have already developed (See previous posts on Collaborative Leadership in the ED and EDQA).

white spaceBelow is a link to a slide set related to how physician leadership plays a vital role.


PS:  Let me know if you will be at MEMC VII this September in Marseille. This is going to be my first trip out there!

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Quality Initiatives: Physician Leadership in the Emergency Department