De-implementing inappropriate urinary catheter use in geriatric patients
Abstract
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.
Related
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- Safe and unsafe urinary catheter use in long-term care homes: a human factors-informed scoping review protocol
- A stretchable liquid-metal bioelectric catheter for active management of catheter-associated urinary tract infections
- Implementing a nurse-led care bundle to reduce indwelling pleural catheter-related complications: a quality improvement project
- Systematic review of risk prediction models for catheter-associated urinary tract infection
BibTeX
@article{koscherkien2026deimplementing,
title = {{De-implementing inappropriate urinary catheter use in geriatric patients}},
author = {C Koscher-Kien and DV Hebesberger and R Cody and J Daxenbichler and M-T Schultes},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1568},
url = {https://doi.org/10.1093/eurpub/ckag169.1568},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - De-implementing inappropriate urinary catheter use in geriatric patients
AU - C Koscher-Kien
AU - DV Hebesberger
AU - R Cody
AU - J Daxenbichler
AU - M-T Schultes
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1568
UR - https://doi.org/10.1093/eurpub/ckag169.1568
AB - 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.
SN - 1101-1262
SN - 1464-360X
ER -