Urinary catheter removed on Postoperative Day 1 (POD 1) or Postoperative Day 2 (POD 2) with day of surgery being day zero (NQF 0453)

EMeasure Name Urinary catheter removed on Postoperative Day 1 (POD 1) or Postoperative Day 2 (POD 2) with day of surgery being day zero EMeasure Id 6AFD1100-3A17-486A-A148-E01F065D229F
Version number 1 Set Id DF040C64-91C5-4B7C-B957-C307D57FE59A
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward Oklahoma Foundation for Medical Quality
Endorsed by National Quality Forum
Description Surgical patients with urinary catheter removed on Postoperative Day 1 or Postoperative Day 2 with day of surgery being day zero.
Copyright
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
It is well-established that the risk of catheter-associated urinary tract infection (UTI) increases with increasing duration of indwelling urinary catheterization. In 2000, Saint reported the results of a pooled analysis of 10 prospective trials dating from 1983 to 1995 which estimated that bacteriuria will develop in 26% of patients after 2 to 10 days of catheterization (95% CI 23-25%). Additional pooled analyses demonstrated that 24% (95% CI 16% to 32%) of those patients will develop symptomatic UTI and bacteremia will develop in 3.6%. Among surgical patients, two studies of postoperative patients discharged to subacute care with urinary catheters were more likely to be readmitted to the hospital with a UTI compared with those who had catheters removed prior to hospital discharges (Wald, 2005 and Wald, 2008). Among selected major surgical patients in the Surgical Infection Project (SIP) cohort, Wald demonstrated (in press) that 85% had perioperative indwelling catheters placed and half of those patients had catheters for greater than 2 days postoperatively. These patients were twice as likely to develop UTIs prior to hospital discharge. On multivariate analysis, those who had indwelling bladder catheters for more than 2 days postoperatively were 21% more likely to develop UTI, significantly less likely to be discharged to home, and had a significant increase in mortality at 30 days. Additional analyses suggest that there is sizeable variation in the duration of postoperative catheterization among hospitals and that hospital factors may account for this variation. In 2006, Stephan reported the results of a multifaceted intervention study in orthopedic surgery patients in which protocols limiting the use and duration of postoperative catheterization played a large role. They reported a resultant 60% reduction in UTI incidence-density.
Clinical Recommendation Statement
Minimizing the duration of indwelling urinary catheterization can reduce the risk of catheter-associated urinary tract infection.
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
Saint S. Clinical and economic consequences of nosocomial catheter-related bacteremia. Am J Infect Control 2000; 28: 68-75.
Reference
Stephan F, Sax H, Wachsmuth M, et al. Reduction of urinary tract infection and antibiotic use after surgery: a controlled, prospective before-after study. Clin Infect Dis. 2006; 42; 1544.
Reference
Wald HL, Ma A, Bratzler DW, Kramer AM. Indwelling Urinary Catheter Use in the Postoperative Period: Analysis of The National Surgical Infection Prevention Project Data. Arch Surg. In press.
Reference
Wald H, Epstein A, Kramer A. Extended Urinary Catheterization Among Hip Fracture Patients Discharged to Skilled Nursing Facilities. Med Care 2005; 43:1009-1017.
Reference
Wald HL, Epstein AM, Radcliff TA, Kramer AM. Extended Use of Urinary Catheters in Older Surgical Patients: A Patient Safety Problem? Infect Cont Hosp Epidemiol 2008; 29:116-124.
Definition
Guidance
The measurement period is one calendar year but the reporting period is 3 months as a calendar quarter; Q1 = Jan – Mar, Q2 = Apr – Jun, Q3 = Jul – Sep, Q4 is Oct – Dec.

Patients for whom there are missing or inaccurate data (e.g., arrival time, medication administration, etc.) are considered to have failed the measure; the total number of patients with missing or erroneous (e.g., a time of 03:69 or a date of 10/26/2035) data (i.e., measure failures) must be reported with the results of the measure.

General guidance:

The original measure excludes patients who have had a laparoscopic procedure unless the laparoscopic incision has been extended during the procedure.  ICD-10 allows definition of such extension with procedure codes; ICD-9 does not. For those using ICD-9 any laparoscopic procedure that extends the incision should be included. In this measure the code lists that describe types of surgical procedures remain only in ICD-9 or ICD-10 because the concepts that apply are limited to a very specific subset of all surgical procedures.

Denominator element guidance:

The denominator in this measure specifically excludes surgical procedures that may be associated with post-operative indwelling urinary catheter usage and that occur in close time proximity to the index major surgical procedure. Previous CABG and 'other cardiac surgery' procedures allow exclusion if performed within 4 days before or after the index major surgical procedure.  Other major surgical procedures allow exclusion if performed within 3 days before or after the index major surgical procedure. 

Exclusion element guidance:

The exclusion for patients who are clinical trial participants is limited to patients participating in a clinical trial for the same conditions as covered by the measure. Other clinical trials are not valid reasons for exclusions. 

The original specification for this measure allowed an exclusion for patients with pacemaker or implantable defibrillator insertions within 4 days of CABG or other cardiac procedures or 3 days for other surgery.  

By convention, discharge date post "encounter inpatient" is used to describe the hospital discharge date.  Where logic needs to indicate discharge (or transfer) from one inpatient location to another, the logic uses "transfer from" or "transfer to" as the QDS data type.

Table of Contents


Population criteria

Data criteria (QDS Data Elements)

Summary Calculation

Calculation is generic to all measures:



Measure set CLINICAL QUALITY MEASURE SET 2011-2012