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Reducing Foley Insertion and Urinary Retention Consults: A Single Center Quality Improvement Project
Christian Schaufler, MD, Peter L. Steinberg, MD.
Beth Israel Deaconess Medical Center, Boston, MA, USA.
INTRODUCTION: Catheter insertion and urinary retention are common inpatient urologic consults, though many such consults do not require urologic expertise. Limited staff training on Foley insertion and lack of standardized protocols to manage simple retention consults lead to inefficient urology consult resource use. This quality improvement project aimed to reduce consult frequency through targeted nursing education on Foley insertion and urinary retention protocol development.
MATERIALS AND METHODS: Consult data were collected from the EHR during pre-intervention (June-July 2024) and post-intervention (January-March 2025) periods, each spanning 60 days. Consults were classified as simple or complex. Foley consults were simple if resolved with phone guidance or if a resident placed a catheter on the first attempt using an 18Fr coudee. Retention consults were simple if patients were without AKI, UTI, or recent urologic surgery, or retention was due to constipation, immobility, or altered mental status. A urinary retention management algorithm was developed with input from hospitalist leadership. The difficult Foley algorithm was revised, in-person nursing education conducted, and an instructional video was created to reinforce proper coudee placement technique. A chi-squared test compared the incidence of simple consults between periods.
RESULTS: Pre- and post-intervention, total urology consults were 344 and 327, with 91 and 80 Foley-related or retention consults, respectively. Retention and Foley-related consults categorized as simple improved from 62.6% to 48.8% (p=0.002). Foley placement consults categorized as simple were 54.5% pre-intervention and 48.6% post-intervention (p=0.07). 65.7% of retention consults were simple pre-intervention vs. 56.3% post-intervention (p=0.19).
CONCLUSION: Nursing education and protocol development were associated with a reduction in the incidence of total Foley-related and urinary retention consults and the proportion of simple Foley placement and retention consults. Limitations include small sample size and short follow-up. Continued nursing education and broader adoption of established algorithms may further reduce unnecessary consultations over time.
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