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Reduction of Urinary Catheters

Measure Purpose: Reduct UTI prevalence in patients with neurologic conditions

The numerator: The hospital has a protocol for rational urinary catheter use specifically in neurologically ill patients, including stroke and altered mental status*, that contains a list of appropriate indications for catheter placement. Efforts should be made to avoid usage of catheters in neurologically ill patients given their relationship with Catheter Association Urinary Tract Infection (CAUTI)

*See measure specifications for additional details

is divided by

The denominator: All hospitals that care for patients with neurological illness including stroke and altered mental status


Key Phrases

Key phrases you should use to document this measure include:

  • Utilized hospital catheter protocol
  • Catheter protocol followed

Measure Calculation Example

Best Neurological Care and Hospital convenes a panel of experts from their various departments to evaluate development of a protocol for urinary catheter use for neurologically ill patients. The panel develops a protocol that addresses avoidance of catheters for neurologically ill patients, including those with stroke, transient alteration of awareness, encephalopathy, dizziness, delirium, and other altered mental status diagnoses.

The protocol is implemented on January 1 of the measurement year. The measure is met.