Friday, October 24, 2008

Update on "Never Events"

As a follow-up to our earlier post on Medicare "never events", physician-blogger WhiteCoatRants reports on what has happened in his ER (emphasis mine):
Well it's been two weeks since "never events" were implemented. What changes have been made?

Probably the biggest change in our ED is the decrease in use of Foley catheters. Since October 1, a Foley cannot be placed without an order that also states the medical necessity for the catheter. The doctors apparently don't want to have their judgment questioned, so very few patients get Foley catheters any more.

...I'm sure that the decrease in Foley catheter use will also decrease the number of UTIs due to Foley catheter use. That's a good thing, right?

...How do you tell if an infection is "from using tubes"? I was able to find one lecture from a UK physician that defined a catheter associated UTI as one in which "An indwelling catheter is in situ at time of onset of UTI" -OR- "An indwelling catheter was removed within 3 days prior to the onset of UTI." Both definitions require an indwelling catheter. Therefore if no indwelling catheters are used and only a straight catheter being used repeatedly, by this definition a "catheter associated UTI" cannot develop.

That explains one of the other things I am seeing: Instead of getting indwelling Foley catheters, patients are now repeatedly getting straight catheters to retrieve urine. That amounts to more work for the nurses, more patient discomfort, and more trauma to the urethra as the catheter is repeatedly inserted.

...Will the decrease in UTIs offset the inevitable increase in the numbers of decubitus ulcers, the decrease in patient comfort, and the lack of trust in the medical system when "that nurse just left grandma laying in her urine all afternoon"? That remains to be seen, but I doubt it.
I'm predicting that this won't be the only unintended consequence of these new government laws...

(Via KevinMD.)