{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T16:35:00Z","timestamp":1759336500037},"reference-count":44,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2015,8,20]],"date-time":"2015-08-20T00:00:00Z","timestamp":1440028800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2015,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Indwelling urinary catheters (<jats:styled-content style=\"fixed-case\">IUC<\/jats:styled-content>s) are placed frequently in older adults (age \u2265 65 years) in the emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>) and carry significant risks. The authors developed, implemented, and assessed a novel clinical protocol to assist <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> providers with appropriate indications for placement, reassessment, and removal of <jats:styled-content style=\"fixed-case\">IUC<\/jats:styled-content>s in elders in the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A comprehensive, evidence\u2010based clinical protocol was built from an extensive literature review and <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> provider focus groups. It was implemented at a university\u2010based medical center with a 20\u2010minute scripted slide presentation. Written surveys were administered before, after, and at 6 months to assess providers' baseline practice and the protocol's effects. Surveys included asking providers for <jats:styled-content style=\"fixed-case\">IUC<\/jats:styled-content> management decisions in 25 unique clinical scenarios. Rates of <jats:styled-content style=\"fixed-case\">IUC<\/jats:styled-content> placement and catheter\u2010associated urinary tract infections (<jats:styled-content style=\"fixed-case\">CAUTI<\/jats:styled-content>s) were compared in <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> older adult patients admitted to the hospital in the 6 months before and after protocol implementation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 111 <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> providers participated in the all three surveys. Immediately after protocol introduction, providers anticipated that this intervention would reduce rates of <jats:styled-content style=\"fixed-case\">IUC<\/jats:styled-content> use and increase patient safety. At 6\u2010month follow\u2010up, 81% felt the protocol had changed their practice, and 39% reported frequently referencing the protocol. In the clinical vignettes, <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> providers correctly identified the appropriate approach for <jats:styled-content style=\"fixed-case\">IUC<\/jats:styled-content> placement in 63% of cases at baseline with an increase of 22% (95% confidence interval [<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>]\u00a0=\u00a019% to 25%) postintervention and an increase of 8% (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a06% to 12%) between baseline and 6 months. An absolute reduction in the use of <jats:styled-content style=\"fixed-case\">IUC<\/jats:styled-content>s of 3.5% (p\u00a0&lt;\u00a00.001) for older adults admitted to the hospital was observed after implementation of the protocol. There were three <jats:styled-content style=\"fixed-case\">CAUTI<\/jats:styled-content>s attributable to the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> in the 6 months prior to implementation and none in the 6 months after.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This comprehensive, evidence\u2010based clinical protocol was well received by participants and was associated with a sustained change in self\u2010reported practice, as supported by a reduction in <jats:styled-content style=\"fixed-case\">IUC<\/jats:styled-content> placement in admitted older adults and a reduction in <jats:styled-content style=\"fixed-case\">CAUTI<\/jats:styled-content>s attributable to the <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> for this vulnerable population over the 6\u2010month study period.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.12748","type":"journal-article","created":{"date-parts":[[2015,8,20]],"date-time":"2015-08-20T16:14:55Z","timestamp":1440087295000},"page":"1056-1066","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["A Novel Clinical Protocol for Placement and Management of Indwelling Urinary Catheters in Older Adults in the Emergency Department"],"prefix":"10.1111","volume":"22","author":[{"given":"Mary R.","family":"Mulcare","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine Weill Cornell Medical College New York NY"},{"name":"Emergency Medicine Residency New York\u2013Presbyterian Hospital New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tony","family":"Rosen","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine Weill Cornell Medical College New York NY"},{"name":"Emergency Medicine Residency New York\u2013Presbyterian Hospital New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sunday","family":"Clark","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine Weill Cornell Medical College New York NY"},{"name":"Emergency Medicine Residency New York\u2013Presbyterian Hospital New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kartik","family":"Viswanathan","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine Weill Cornell Medical College New York NY"},{"name":"Division of Geriatrics and Gerontology Weill Cornell Medical College New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaime Lynn","family":"Hayes","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine Weill Cornell Medical College New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael E.","family":"Stern","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine Weill Cornell Medical College New York NY"},{"name":"Emergency Medicine Residency New York\u2013Presbyterian Hospital New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neal E.","family":"Flomenbaum","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine Weill Cornell Medical College New York NY"},{"name":"Emergency Medicine Residency New York\u2013Presbyterian Hospital New York NY"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,8,20]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12334"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1086\/657912"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1306801"},{"key":"e_1_2_7_5_1","first-page":"99","article-title":"Overutilization of indwelling urinary catheters and the development of nosocomial urinary tract infections","volume":"6","author":"Gardam MA","year":"1998","journal-title":"Clin Perform Qual Health Care"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.emc.2008.01.002"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2010.12.041"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-159-6-201309170-00006"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2003.08.007"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1086\/651091"},{"key":"e_1_2_7_11_1","first-page":"73","volume-title":"Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices","author":"Meddings J","year":"2013"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1086\/501837"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2318-6-15"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1086\/589584"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2011.05.012"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1086\/675718"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1086\/529589"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1086\/524662"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jen.2009.11.002"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1136\/postgradmedj-2011-130287"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2009.00677.x"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2014.02.013"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2006.12.004"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jen.2012.07.022"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2014.12.008"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehi044"},{"key":"e_1_2_7_27_1","first-page":"e000473","article-title":"Will more restrictive indications decrease rates of urinary catheterisation?","volume":"2","author":"Shimoni Z","year":"2012","journal-title":"An historical comparative study. BMJ Open"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.4065\/76.3.295"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/0020-1383(95)92183-B"},{"key":"e_1_2_7_30_1","first-page":"29","article-title":"Skin care in the frail, elderly, dependent, incontinent patient","volume":"9","author":"Jeter K","year":"1996","journal-title":"Adv Wound Care"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2012.05.014"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12375"},{"key":"e_1_2_7_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-011-1935-y"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2009.05.005"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2010.03.011"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jen.2015.02.013"},{"key":"e_1_2_7_37_1","unstructured":"Centers for Disease Control and Prevention.Urinary Tract Infection (Catheter\u2010Associated Urinary Tract Infection [CAUTI] and Non\u2010Catheter\u2010Associated Urinary Tract Infection [UTI]) and Other Urinary System Infection [USI]) Events. Available at:http:\/\/www.cdc.gov\/nhsn\/pdfs\/pscmanual\/7psccauticurrent.pdf. Accessed Jun 26 2015."},{"key":"e_1_2_7_38_1","unstructured":"American College of Emergency Physicians.Choosing Wisely: Five Things Physicians and Patients Should Question. Available at:http:\/\/c.ymcdn.com\/sites\/www.texacep.org\/resource\/resmgr\/Presentations_2014_P2\/TroutmanChoosing_Wisely__Lis.pdf. Accessed Jun 26 2015."},{"key":"e_1_2_7_39_1","unstructured":"RosenbergMS CarpenterCR BromelyM et\u00a0al.Geriatric Emergency Department Guidelines. Consensus document for American College of Emergency Physicians Society of Academic Emergency Medicine American Geriatrics Society and Emergency Nurses Association. Available at:http:\/\/www.google.com\/url?sa=&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0CCUQFjAB&url=http%3A%2F%2Fwww.acep.org%2Fworkarea%2FDownloadAsset.aspx%3Fid%3D95365&ei=fwOOVc6dKpLkoASRyajYBw&usg=AFQjCNFYMM5SQVh_kG-jpCFXgfjcrtWhbQ&bvmbv96783405 d.cGU. Accessed Jun 26 2015."},{"key":"e_1_2_7_40_1","first-page":"337","article-title":"Systems initiatives reduce healthcare\u2010associated infections: a study of 22,928 device days in a single trauma unit","volume":"17","author":"Miller R","year":"2010","journal-title":"J Trauma"},{"key":"e_1_2_7_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2010.04.219"},{"key":"e_1_2_7_42_1","doi-asserted-by":"publisher","DOI":"10.1086\/650482"},{"key":"e_1_2_7_43_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.101"},{"key":"e_1_2_7_44_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrurol.2012.68"},{"key":"e_1_2_7_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2012.04.328"}],"container-title":["Academic Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Facem.12748","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.12748","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T13:18:43Z","timestamp":1696511923000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acem.12748"}},"subtitle":[],"editor":[{"given":"Kennon","family":"Heard","sequence":"additional","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2015,8,20]]},"references-count":44,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2015,9]]}},"alternative-id":["10.1111\/acem.12748"],"URL":"https:\/\/doi.org\/10.1111\/acem.12748","archive":["Portico"],"relation":{},"ISSN":["1069-6563","1553-2712"],"issn-type":[{"value":"1069-6563","type":"print"},{"value":"1553-2712","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,8,20]]},"assertion":[{"value":"2015-01-30","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-04-23","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-08-20","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}