Are physicians aware of which of their patients have indwelling urinary catheters?

PURPOSE: Although infections associated with indwelling urinary catheters a re common, costly, and morbid, the use of these catheters is unnecessary in more than one-third of patients. We sought to assess whether attending phy sicians, medical residents, and medical students are aware if their hospita lized patients have an indwelling urinary catheter, and whether physician a wareness is associated with appropriate use of these catheters. METHODS: The physicians and medical students responsible for patients admit ted to the medical services at four university-affiliated hospitals were gi ven a list of the patients on their service. For each patient, the provider was asked: "As of yesterday afternoon, did this patient have an indwelling urethral catheter?" Respondents' answers were compared with the results of examining the patient. RESULTS: Among 288 physicians and students on 56 medical teams, 256 (89%) c ompleted the survey. Of 469 patients, 117 (25%) had an indwelling catheter. There were a total of 319 provider-patient observations among these 117 pa tients. Over all, providers were unaware of catheterization for 88 (28%) of the 319 provider-patient observations. Unawareness rates by level of train ing were 21% for students, 22% for interns, 27% for residents, and 38% for attending physicians (P = 0.06). Catheter use was inappropriate in 36 (31%) of the 117 patients with a catheter. Providers were unaware of catheter us e for 44 (41%) of the 108 provider-patient observations of patients who wer e inappropriately catheterized. Catheterization was more Likely to be appro priate if respondents were aware of the catheter (odds ratio = 3.7; 95% con fidence interval, 2.1 to 6.7, P<0.001). CONCLUSION: Physicians are commonly unaware that their patients have an ind welling urinary catheter. Inappropriate catheters are more often "forgotten " than appropriate ones. System-wide interventions aimed at discontinuing u nnecessary catheterization seem warranted. Am J Med. 2000;109: 476-480. (C) 2000 by Excerpta Medica, Inc.