De-implementing inappropriate urinary catheter use in geriatric patients

Background

Indwelling urinary catheters (IUCs) offer clear clinical benefits when used appropriately; however, in geriatric care, up to 50% of their use is considered inappropriate. This form of low-value care is associated with substantial risks.

Methods

This qualitative study was part of a larger research project which synthesised multi-level influences on inappropriate IUC use as well as the effectiveness of de-implementation strategies. We purposively sampled interviewees representing diverse perspectives in Austria and Switzerland. We conducted semi-structured interviews with representatives from professional groups, patient organisations, and health authorities (n = 14). In 5 hospitals and 3 long-term care facilities, we interviewed healthcare professionals (n = 72), and geriatric patients/residents (n = 12). All interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis.

Results

Factors influencing IUC use operated across multiple levels. At the national level, initiatives such as campaigns and regular quality audits influenced awareness and supported appropriate catheter use. At the organisational level, several barriers were identified. Guideline-related determinants, including insufficiently specific indication criteria, led to inconsistent interpretation and decision-making. Process-related determinants, particularly the lack of routine daily reassessment, contributed to unnecessarily prolonged catheterization. In addition, resource and feasibility constraints, such as the perceived limited practicality of alternative urinary management options, further hindered appropriate use. Appropriate use was supported by strong nursing commitment to quality of care, leadership support, and the involvement of specialized nursing experts.

Conclusions

Sustainable improvement requires national-level measures, such as continuous monitoring, alongside organisational-level interventions, including education and structural support.

Key messages

• Enhancing the usability of clinical guidelines, strengthening roles (e.g. continence and stoma care specialists), and promoting feasible alternatives are key strategies to reduce low-value care.

• Experts in the field provided valuable input for refining recommendations and suggested effective dissemination formats, such as One-Minute Wonders.