Urine output:how and why is it monitored in acute medical environments
Research type
Research Study
Full title
Urine output: how and why is it monitored in acute medical environments?
IRAS ID
226223
Contact name
Camilla Bennett
Contact email
Sponsor organisation
University of Southampton
Duration of Study in the UK
0 years, 5 months, 1 days
Research summary
Urinary tract infection is the second most common healthcare-associated infection in hospitals and around 60% of these are attributable to indwelling urinary catheters. Healthcare-associated urinary tract infection has been found to extend the average length of hospital stay by 4 days (Mitchell, 2016), increasing NHS financial cost. Moreover, increased use of antibiotics impacts on the burden and development of antimicrobial resistance (Loveday et al. 2014). Prevention of catheter-associated UTI is therefore classed as a high impact action in healthcare. Better use of urinary catheters is a target for intervention in England to reduce healthcare associated E.coli bloodstream infections (BSI) (Abernethy et al., 2017).
Urine output monitoring is often the documented indication for short-term catheter use. During the summer of 2017, a service evaluation of urine monitoring strategies on 17 wards and units at the proposed study hospital revealed 1 in 4 patients in acute medical wards had an indwelling urinary catheter and almost half of these were in use for urine output monitoring. However, it was not clear how many catheters used for output monitoring were clinically justifiable. The service evaluation identified Acute kidney injury (AKI) and Sepsis as key drivers to detect low urine output, although published guidance lacks clarity on when a catheter is needed. Overuse of urinary catheters in hospital is a known problem, yet the extent to which it is possible to avoid catheter use for urine output monitoring is unclear.
The aim of this research is to explore how and why urine output is monitored in acute medical environments. More specifically, it aims to understand the clinical situations when invasive monitoring (using a urinary catheter and urine meter) is considered necessary over non-invasive collection methods (e.g. urine collection and weighing or urinals, bedpans or incontinence pads; external urinary sheaths; bladder scanning).
A focused ethnographic study will take place in two acute hospital wards. Research participants will include clinical staff (medics, nurses and healthcare assistants) that will be observed in practice and interviewed. Selected patients will also be included in this research through analysis of their medical records.
REC name
South Central - Hampshire A Research Ethics Committee
REC reference
18/SC/0557
Date of REC Opinion
17 Dec 2018
REC opinion
Further Information Favourable Opinion