When guidelines conflict: patient safety, quality of life, and CAUTI reduction in patients with spinal cord injury

Abstract

The current Medicare payment structure and some of the recent guidelines aimed at reducing catheter-associated urinary tract infections may be generating a financial incentive for the protocolized, systematic removal of indwelling catheters in hospitalized patients—including those with spinal cord injury. This creates a tension with the Consortium for Spinal Cord Medicine’s clinical practice guidelines for the management of neurogenic bladder. This article presents a series of cases and a discussion of the implications with regard to patient safety and quality of life.

Access optionsAccess options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

References

  1. 1.

    Yavuzer G, Gök H, Tuncer S, Soygür T, Arikan N, Arasil T. Compliance with bladder management in spinal cord injury patients. Spinal Cord. 2000;38:762–5.

  2. 2.

    Linsenmeyer T, editor. Bladder management for adults with spinal cord injury: a clinical practice guideline for health-care providers. Washington, DC: Consortium of Spinal Cord Medicine, 2006.

  3. 3.

    Linsenmeyer T, editor. Acute management of autonomic dysreflexia: individuals with spinal cord injury presenting to health-care facilities. 2nd ed. Washington, DC: Consortium of Spinal Cord Medicine, 2001.

  4. 4.

    Jackson CR, Acland R. Knowledge of autonomic dysreflexia in the emergency department. Emerg Med J. 2011;28:866–9.

  5. 5.

    Krassioukov A, Tomasone J, Pak M, Craven C, Ghoti M, Ethans K., et al. “The ABCs of AD”: a prospective evaluation of the efficacy of an educational intervention to increase knowledge of autonomic dysreflexia management among emergency health care professionals. J Spinal Cord Med. 2016;39:190–6.

  6. 6.

    Wing P, editor. Early acute management in adults with spinal cord injury: a clinical practice guideline for health-care professionals. Washington, DC: Consortium of Spinal Cord Medicine, 2008.

  7. 7.

    Meddings J, Saint S, Fowler KE, Gaies E, Hickner A, Krein SL., et al. The Ann Arbor criteria for appropriate urinary catheter use in hospitalized medical patients: results obtained by using the RAND/UCLA appropriateness method. Ann Intern Med. 2015;162:S1–S34.

  8. 8.

    Titsworth W, Hester J, Correia T, Reed R, Williams M, Guin P., et al. Reduction of catheter-associated urinary tract infections among patients in a neurological intensive care unit: a single institution’s success. J Neurosurg. 2012;116:911–20.

  9. 9.

    Whiteneck G, editor. Outcomes following traumatic spinal cord injury: clinical practice guidelines for healthcare professionals. Washington, DC: Consortium of Spinal Cord Medicine, 1999.

  10. 10.

    Akkoç Y, Ersöz M, Yıldız N, Erhan B, Alaca R, Gök H., et al. Effects of different bladder management methods on the quality of life in patients with traumatic spinal cord injury. Spinal Cord. 2013;51:226–31.

Download references

Author information

Correspondence to Matthew Davis.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark