A prospective audit on the effect of training and educational workshops on the incidence of urethral catheterization injuries

Abstract

Introduction: The incidence of iatrogenic urethral catheterization (UC) injuries is approximately 0.3%. Resultant complications are associated with patient morbidity and unnecessary healthcare costs. Our aim was to investigate whether educational training workshops decreased the incidence of UC-related injuries. Methods: A prospective audit was performed to calculate incidence, morbidity, and costs associated with iatrogenic UC injury from January to July 2015. Educational workshops were then conducted with healthcare staff and training modules for junior doctors. UC-related incidence, morbidity, and costs in the subsequent six-month period were recorded prospectively and compared with the previous data. Results: The incidence of iatrogenic UC injuries was reduced from 4.3/1000 catheters inserted to 3.8/1000 catheters after the intervention (p=0.59). Morbidity from UC increased in the second half in the form of increase in cumulative additional inpatient hospital stay (22 to 79 days; p=0.25), incidence of urosepsis (n=2 to n=4), and need for operative intervention (n=1 to n=2). The cost of managing UC injuries almost doubled in the period after the training intervention (€50 449 to €90 100). Conclusions: Current forms of educational and training interventions for UC did not significantly change morbidity or cost of iatrogenic UC injuries despite a decrease in incidence. Improved and intensive training protocols are necessary for UC to prevent avoidable iatrogenic complications, as well as a safer urethral catheter design.

Letter to the Editor re: Foundation Year 1 doctors’ experience and confidence in catheterisation: A multicentre survey

“…A lack of regular inspection of procedural-based skills such as catheterisations by senior staff may a contributory factor. 5 In addition, a decline in undergraduate exposure to urology may contribute to the difficulties that foundation year doctors face. However, it is not limited to the UK and is not a new problem, as Benson et al previously demonstrated that 15% of new graduates had never experienced a rotation in urology.…”

“…7 Bhatt et al have conducted a large audit on iatrogenic catheter injuries and noted an incidence of 4.3/1000. 5 They also introduced a practical compulsory male catheterisation session for all newly qualified house officers, supervised by a member of the urology team. 5 Following this novel idea a reduction in catheter-related injuries was noted.…”

“…5 They also introduced a practical compulsory male catheterisation session for all newly qualified house officers, supervised by a member of the urology team. 5 Following this novel idea a reduction in catheter-related injuries was noted. 5 Specific to our institution, all third year undergraduates undergo a 6-week rotation in surgery, with 2 weeks each in urology, general surgery and breast/oncoplastics.…”

“…5 Following this novel idea a reduction in catheter-related injuries was noted. 5 Specific to our institution, all third year undergraduates undergo a 6-week rotation in surgery, with 2 weeks each in urology, general surgery and breast/oncoplastics. Clinical exposure is maximised in all specialties, and a dedicated consultant-delivered lecture on catheter management is given during the urology rotation with support from other specialities.…”

“…8 Undoubtedly, designated catheter education workshops, as proposed by Bhatt et al, and the introduction of novel catheter safety devices such as that devised by Davis et al will increasingly be relied upon to ensure safe catheter management by junior practitioners. 5,9…”