Q Exchange
Using a catheter monitoring system to reduce length of stay
- Proposal
- 2023
What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?
Urinary tract infections (UTI) are commonly acquired by patients receiving healthcare. Older people are particularly vulnerable and life-threatening sepsis associated with UTI is frequently responsible for extended length of stay and hospital re-admissions. Urinary catheters (UC) significantly increase the risk of UTI as they provide a direct route for bacteria to enter the bladder. The longer the UC is in place the greater the risk of infection. It is therefore essential to use them only when necessary and to remove them promptly.
Approximately 20% of hospital patients and 10% of the district nurse caseload have a UC but many of these catheters have been inserted without a clear purpose or the original reason is no longer relevant. In the absence of clear information, staff may be reluctant to remove the UC and patients can end up catheterised for month or years, being put at high risk of repeat UTI and hospital admission.
What does your project aim to achieve?
We aim to develop an app to support data capture on patients with a UC, which generates reports that help clinicians recognise and address problems that cause unnecessary or prolonged catheterisation.
Our objectives:
1. work with a digital solutions company to develop an app which captures a small set of data on patients with UC and generates reports that identify catheters inserted inappropriately or for too long
2. enable improvement by building an evidence-based decision support tool for assessing the need for a UC and enabling removal
3. support communication between acute and community care providers and patients through data recording and sharing
4. build knowledge among care professionals about the risks of UC and delivering safe, effective care by making relevant information readily available
5. develop clear instructions for using the app and how it can contribute to preventing infection, reducing hospital stay and preventing re-admissions
6. promote the app via our professional networks
How will the project be delivered?
We have an established project team that has developed the concept and underpinning documentation to support data capture and reporting. This comprises experts in infection prevention and surveillance data and reporting from acute NHS hospitals, NHSE and academics with expertise in UTI prevention. We will extend to include expertise in continence advice, urology and ward-based staff when we secure funding.
We have established links with a digital solutions company, which has considerable experience of developing apps for the healthcare environment including integrating apps with NHS data management systems and ensuring information governance is in place. We have a refined dataset after preliminary testing to inform app development. The app specification will be tested thoroughly before it’s launch. This will enable measurement of the impact on reducing the use of UC and avoiding UTI. The app will be promoted widely through our professional networks across the UK and links to NHSE.
How is your project going to share learning?
Measurement is fundamental to successful improvement initiatives. The principles of simple data capture and feedback that will be incorporated into this app have the potential for wide application to other improvement challenges.
Prevention of UTI and the challenges associated with driving better management of urinary catheters is recognised as a key priority across the UK and Ireland as it is key to reducing the use of antibiotics and addressing the steady increase in severe bloodstream infections due to UTI observed in the last decade. The project provides opportunities for collaboration across acute and community settings, with multi-disciplinary teams.
Many patients are discharged from hospital with catheters and this work can be extended to improve patient safety across the healthcare economy. We have a commitment from an acute/community healthcare trust to test the app and strong links with the Infection Prevention Society and Association of Continence Advisors to spread the app.
How you can contribute
- We would welcome your help with creative ways to present data captured within the app to frontline healthcare staff to engage them in using it to inform improvement.
- We would value your suggestions about how can we effectively promote adoption and spread of this new digital tool to enable improvement activity and share learning.
Plan timeline
| 1 May 2023 | Stakeholder engagement. Tender app design team |
|---|---|
| 5 Jun 2023 | Build and test app |
| 4 Sep 2023 | Implementation phase and data collection |
| 8 Jan 2024 | Data analysis and shared learning |
Comments
Jennie Wilson 28 Mar 2023
This is such an important topic - UTI are a major cause of healthcare associated infection and a significant driver of antimicrobial resistance across both acute and community care settings. There is considerable evidence to show quality improvement initiatives reduce the inappropriate use of catheters and prevent infections. This app is very much needed to provide a structured, evidence-based approach to supporting healthcare staff make decisions about catheters and drive improvement in care. Communication across the healthcare economy is recognised as a problem so an app that can address this will be a big bonus!
Valrie Burgess 27 Mar 2023
This idea sounds very interesting. There is definitely a need for an improvement in the patient pathway from the Acute to community rehab and on to discharge in terms of information sharing. Looking forward to the outcome of this new innovation!
Kind regards,
Valrie
Jacqui Prieto 27 Mar 2023
Thanks Valrie - there's certainly a lot of support for developing a workable solution to help improve the pathway for people with a urinary catheter, particularly on discharge from hospital to the community. And this is exactly what we're hoping to solve.
Best wishes,
Jacqui
Susan Knipes 24 Mar 2023
This sounds a great initiatve, its so needed, we IPC team have just completed a small scale study on daily management of catheter care in nursing and residential care homes. This would make such a difference as passports get lost etc.
Jacqui Prieto 27 Mar 2023
Thanks Susan - its good to know this would be valuable for residents in care home settings too, where unnecessarily prolonged catheter use can be especially problematic for residents and impact on their quality of life.
Best wishes,
Jacqui
Angela Cairns 24 Mar 2023
I think this is a great idea and anything that's helps address the gap between acute and community care is very beneficial. During the last year we have been investigating community acquired GNBSI and this had come up a number of times. We also see it between our acute and community rehabilitation wards.
I would be interested to know where you see this app sitting, with the patient or the staff? Or accessible to both? We have tried passports and they invariably get lost or left, so something that travels with the patient would be excellent.
Thanks
Angela
Jacqui Prieto 27 Mar 2023
Hi Angela,
Thanks for your feedback. We are envisioning the app to be used by healthcare staff as a means of capturing the data required to inform improvements in care and support decisions about review and removal of catheters.
It can be challenging for staff to collect meaningful data to drive improvement and access evidence-based information to inform clinical decision making and so we are seeking to make this much easier to do.
I do completely understand the difficulties around sharing information about patients who have a catheter as they move between healthcare services and sectors and we are hoping the app will support more timely decisions about removal of catheters intended for short-term use.
Best wishes,
Jacqui
Jacqui Prieto 21 Mar 2023
Thanks Ashley - I agree there really is so much potential with this app and the proposed work links to important national agendas in health and social care.
Best wishes,
Jacqui
Ashley Flores 21 Mar 2023
This would be such a valuable tool to use across healthcare systems. I'm sure our ICB would be really keen on this, to use in both acute and community settings. This would be an easy way to measure this aspect of patient care, and really support improvement in patient experience, patient safety, and also a reduction in length of hospital stay and prevention of readmissions.
I can see this tool really helping with the antibiotic stewardship agenda and the gram negative blood stream objectives too!
Carole Hallam 22 Mar 2023
Thanks for your comments Ashley
I totally agree with your comments. The App would be able to provide meaningful data and would be very much welcomed by ICBs, acute and community providers.
Best wishes
Carole
Helen Tucker 20 Mar 2023
This looks a great idea, giving staff ready access to information via an app re catheter care. I agree that piloting in acute hospitals, community hospitals and community services would be very valuable. Good luck with your idea.
Esther Taborn 21 Mar 2023
Thanks Helen, I am particularly keen to work with community colleagues to explore how we can use this app to improve access to health care and decision making. Supporting staff to move to a TWOC or refer to continence services or teach intermittent self catheterisation if those options are viable. Having something that clinicians can directly refer to in a patient's home.
Additionally acute sector use will have a indirect benefit on all patient's meaning that less are discharged with catheters and therefore more community nursing time is freed to support other aspects of care
Jacqui Prieto 21 Mar 2023
Thanks Helen - it's good to know you can see the value in this as a whole system approach. We are seeking to improve the pathway for patients with a catheter given how they move between services and sectors, with active review and removal plans frequently getting lost along the way.
Best wishes,
Jacqui
Jacqui Prieto 20 Mar 2023
Thanks very much Isata. We are aiming for exactly this - an app that will provide frontline staff with ready access to the information they need to support discussion with the multidisciplinary team about early catheter removal to minimise risk of catheter-related harms. Our discussions with staff indicate this could unlock best practice and make it easier for them to do the right thing.
Best wishes,
Jacqui
isata kamara 18 Mar 2023
Brilliant idea, an app could provide easy access to staff to document or easily retrieve relevant information regarding the catheter, which could lead to TWOC discussion or action that could prevent infection
Esther Taborn 21 Mar 2023
HI Isata
I agree yes, this app would really help support prompt decision making and therefore more effective and timely discharge. Reducing the delay in making that decision about a TWOC, meaning that patients get timely access to appropriate healthcare. Including of course the catheter being put back in and referral to specialist services if that's what is appropriate.
Best wishes
Esther
Carole Hallam 20 Mar 2023
Hi Isata
Thank you for your comments. You are absolutely right about the potential to prompt TWOC and reduce risk of infection. This not only improves the patient experience and patient safety but also plays a great role in reducing the risk of antimicrobial resistance. No UTI = no antibiotics needed, hopefully a win win.
Best wishes
Carole
Jacqui Prieto 15 Mar 2023
Thanks Maura. We agree about the need to co-design and pilot the app and have secured the commitment of NHS providers for both hospital and community services so that we can better understand the needs of patients in both settings. I also agree about the importance of longer-term thinking here around potential use outside of the NHS.
Thanks again for your support and feedback.
Best wishes,
Jacqui
Maura Smiddy 15 Mar 2023
I think this is a valuable idea that would reduce risks for patients in many healthcare areas. I support the idea of a pilot project in terms of application and evaluation. A co-design approach to the app would be very valuable and you could run this in advance of the pilot perhaps in up to four sites that best represent this patient population. This would also support ownership and implementation.
Another consideration for the future would be the ability of the app to integrate with patient information systems outside of the NHS as this would be beneficial in a much wider context and could potentially be extended to other mid/long term invasive devices?
Best of luck!
Maura.
Carole Hallam 20 Mar 2023
Hi Maura
Thanks for your feedback. I think there would be a real potential for the App to be adapted for data collection for other devices, particularly vascular access devices. As we know, urinary catheters and vascular access devices are the most used invasive devices and there is a lack of data routinely collected for these devices. Without the data we have no measure of the problems or the improvements.
Best wishes
Carole
Mel Johnson 8 Mar 2023
Great idea, an area where there is lots of unintentional serious harm and negative effects on peoples lives.
Data presentation can be tricky on Apps, simple displays that colleagues can see on phones , perhaps something that shows instantly what progress is being made to maintain engagement as well as helps identify patients at risk so they can be targeted?
I would suggest starting to test at a Trust that also has both acute and community services, may reduce some of the IG processes but also allow you to test a whole system approach?
Good luck!
Mel
Carole Hallam 8 Mar 2023
Thanks Mel and Jacqui
I think it will be important to do a small test of the data to see that the data is useful and in a format that can engage with staff. Using co-design of the app would be a good idea as we need staff to want to use it, and feel it is a benefit.
Warm regards
Carole
Jacqui Prieto 8 Mar 2023
Thanks Mel, that's really helpful. I agree about the application to acute and community services as there are two strands to this - one focusing on early removal of catheters used for short-term indications in hospital (e.g. urine output measurement and management of acute urinary retention) and the other on timely review and active management of catheters with a longer-term indications to ensure that catheters intended for temporary use don't become permanent by default.
It would be ideal if feedback via the app can serve to motivate healthcare staff to take action to review and remove catheters as soon as no longer needed. Some kind of visual tracker of collective efforts and progress over time by healthcare teams would be good. I can also see how being able to identify individual patients at risk would help staff to focus efforts on any given day.
Thanks once again.
Jacqui
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