Changes in Discharge Location and Readmission Rates Under Medicare Bundled Payment

Abstract

Risks Associated With CathetersWhen I was an intern, we frequently placed urinary catheters in hospitalized patients.For some diagnoses, like congestive heart failure, we believed placement of a urinary catheter was almost mandatory to accurately measure fluid output during diuresis.We were well meaning and thought more monitoring of intake and output meant better care.The problem was that we focused more on getting information than how it actually added value to our clinical assessment, and we did not consider the possible and likely complications of catheter placement.In most cases, the risks of catheter placement outweigh any possible benefits.We are familiar with the dramatically increased risk of infection in patients with urinary catheters.But their immobilizing effects are equally serious.Saint et al 1 has described the urinary catheter as a 1-point restraint that renders the hospital patient bedbound.Hospital immobility leads to more weakness and hospital-acquired disability, a syndrome in which older patients leave the hospital with new and often permanent disabilities in their basic activities of daily living, even when their medical diagnoses are successfully treated.This disability renders patients in need of institutional long-term care or care by family or friends.There is emerging evidence that the urinary catheter is an instigator of hospital-acquired disability. 2 It is best to avoid placing urinary catheters.However, when catheters are placed, Leis et al 3 describe a pragmatic and innovative approach to help us remove them as expeditiously as possible.By empowering nurses to remove urinary catheters that are no longer needed, they were able to markedly reduce the number of days patient spent with these cath-eters.This is a promising innovation.We need more teambased interventions that improve patient care and safety.

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