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Catheter patients ‘need more district nurse support’ to reduce A&E visits

  • 6 Comments

Better strategies are needed so issues with long-term urinary catheters can be ”addressed and managed effectively” in the community, rather than accident and emergency, suggests a UK study.

Problems with long-term urinary catheters create a “considerable demand” on emergency departments and are very costly, warned the authors of the new study from South East London.

“Only 14% of patients actually saw a community nurse beforehand”

Li June Tay

Researchers from King’s College Hospital NHS Foundation Trust conducted an audit of patients presenting in A&E with problems associated with long-term urinary catheter use and assessed the availability of community nursing support.

In all, 78 patients with a urinary catheter problem presented to the trust’s A&E over a 69-day period, of 68% had a long-term catheter.

The average age of A&E attendees was 74 years and the average duration the catheter had been in place was 11 months.

Among the participants in the study, the most common reasons for attendance were found to be a blocked catheter (47%) and catheter-bypass (23%).

Only 36% were known to district nursing services, while 14% had been referred by a district nurse.

Nurse arrives at a patient's home

Catheter patients ‘need more district nurse support’

Catheter patients ‘need more district nurse support’

Most of the remainder self-referred to A&E and none of the patients in the study had any documented contact with their GP.

The researchers noted that 82% of the patients subsequently had their catheter issues “addressed adequately” by A&E nurses or doctors, without any specialist urology involvement.

“Most patients had minimal community nurse support,” said the researchers in the journal BJU International.

“More than 80% of patients attended the emergency department for a simple catheter problem, and only 14% actually saw a community nurse beforehand,” added lead study author Dr Li June Tay.

  • 6 Comments

Readers' comments (6)

  • I have personally had catheter fitted and was subsequently treated as an outpatient, the service I received at the Derby Royal was very good other than there was only one sit down toilet for upto 10 men ,which was rather inconvenient at times.
    non of the people were being treated by District Nurses and in fact one chappy of 87years had actually been refused treatment for a leaking problem by the local Nurse and was told to get it attended to at his next hospital visit (for which he had to wait 8weeks as the hosptial had lost his notes).
    So what sounds like a good idea needs to be thrashed out with ALL concerned before being implamented.

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  • This awful state of affairs is partly due to the increase in the ageing population that was anticipated years ago, combined with an anticipated fall in district nurse numbers as many were coming up to retirement, poor workforce planning, not replacing district nurses as they left/retired, generally not enough district nurses to go round, despite the increase in need. On top of that general trend towards asking more of unqualified staff and giving more and more responsibility to those that are qualified, means that district nurses are constantly prioritising patient needs. Unfortunately in many cases patients needing catheter care fall by the wayside.

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  • The problem is poor discharge planning and poor communication from hospitals, so that DN's are not informed about these patients. In turn it is poor information being given to patients that they think their only option is to go to A&E!

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  • Gary Musgrove

    Yeah I kind of agree with all of the above including more support needs to be offerd by community nurses. Having said that, being an emergency urology nurse practitioner in an exclusive unit solely for urology emergencies, I do think secondary care needs to support community nurses more by offering speciality education and meeting up with community nurse and patient to plan a solution to the given problem.

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  • Lisa is correct. Often not informed by hospitals if sent home with catheter. Often by clinics are the worst. They not good at informing as most patients are mobile and not housebound. Often patients will be given no spare products. Have to go to a&e till gp gets the script.

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  • Am confused at this. i am a community nurse and in our DN Team we know all patients in our area who have a catheter and we manage these patients accordingly, recatheterise at the appropriate time, recatheterise in emergency when blocked/bypassing, we TWOC if needed and then bladder scan afterwards. At our local hospital, if somebody has been catheterised whilst in, they are discharged with 7 days supplies of night/leg bags, informed by the ward what catheter has been inserted and could we call within a couple of days to reassess and organise supplies. If an emergency catheterisation, they come out of hospital with a TWOC date. If problems at the weekend, the community nurses can and usually do recatheterise. It is a rare occasion if any of our patients with catheters go to ED with catheter problems.

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