Yale Wins Thompson Award

For Urinary Catheter Project

Yale-New Haven Hospital (YNHH) has won the prestigious John D. Thompson Award for the third straight year for using data to improve the quality of health care. The award is sponsored by the Connecticut Hospital Association (CHA).

Yale-New Haven Hospital won this year for its pilot program to reduce urinary catheter-associated urinary tract infections (UTI), the most common in-hospital infection. YNHH created a database to determine the relationship between catheterization and infection, track the rate of infection, and lower it if it proved to be high.

“We knew we had significant number of urinary infections due to Foley catheters,” said Thomas Balcezak, MD, associate chief of staff and assistant and clinical professor of medicine. “We knew that after five days, 50 percent of all patients with a Foley catheter will have bacteria in their urine and by day 30, virtually all patients will have bacteria. The team here set out to calculate the number of our urinary-catheter patient days and if we could reduce the number of days patients using the catheter, we believed we could reduce the number of infections.”

To decrease the number of patients who are catheterized doctors at YNHH were asked to discontinue unnecessary catheters or limit the use of catheter placement to 48 hours. The staff also created a “speed-bump” to force staff to stop and rethink how essential the urinary catheter was for each patient. Even when the patient qualified for a catheter, staff limited the number of days the catheter was in place. In addition, nurses proactively examined and removed catheters from patients who no longer met the established criteria, reducing the risk of infection.

In its first year, the hospital’s pilot program achieved remarkable results. Patients on the five-piloted units realized a 51 percent reduction in catheter-associated UTIs. YNHH achieved a 42 percent reduction in catheter days and a 47 percent reduction in its rate of catheter-associated UTIs.

“For 40 years, hospitals have ordered catheters without considering the risk of infection to the patient,” said Sandy Conklin, RN, clinical effectiveness specialist at Yale-New Haven Hospital.

“We are now thinking critically about urinary catheters and because of the results of this study, we better understand the risk of catheterization and have improved our practice as well. The clinical effect is a new model of care that greatly enhances our level of patient safety.”

Connecticut Hospital Association judges projects that are submitted “blind,” judging each project with no knowledge of the sponsoring hospital to ensure that each project is judged solely on its performance.