eMeasure Title

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

eMeasure Identifier (Measure Authoring Tool) 178 eMeasure Version number 6.4.000
NQF Number Not Applicable GUID d78ce034-8288-4012-a31e-7f485a74f2a9
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward Centers for Medicare & Medicaid Services (CMS)
Measure Developer Oklahoma Foundation for Medical Quality
Endorsed By None
Description
Surgical patients with urinary catheter removed on Postoperative Day 1 or Postoperative Day 2 with day of surgery being day zero
Copyright
Measure specifications are in the Public Domain

LOINC(R) is a registered trademark of the Regenstrief Institute.

This material contains SNOMED Clinical Terms (R) (SNOMED CT(C)) copyright 2004-2015 International Health Terminology Standards Development Organization. All rights reserved.
Disclaimer
These performance measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The measures and specifications are provided without warranty. CMS has contracted with Mathematica Policy Research and its subcontractors, Lantana and Telligen, for the continued maintenance of this electronic measure.
Measure Scoring Proportion
Measure Type Process
Measure Item Count
Encounter, Performed: Encounter Inpatient
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
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
Improvement noted as an increase in rate
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. 2008;143(6):551-557.
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
None
Guidance
Perioperative death: The patient expired during the timeframe from surgical incision through discharge from the post anesthesia care/recovery area. For patients discharged from surgery and admitted to locations other than the PACU (eg, ICU): The perioperative period would end a maximum of six hours after anesthesia ends.

Postoperatively includes the recovery period, which is defined as 'within 6 hours after the end of anesthesia' for the selected surgeries. 

Devices applied such as suprapubic catheters, illeal-conduit urostomy bag, urostomy bag, or ileostomy sets and bags indicate Urinary Diversions. 

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.
Transmission Format
TBD
Initial Population
All hospital discharges for principal selected surgeries with hospital stays <= 120 days during the measurement period for patients age 18 and older at the time of hospital admission
Denominator
All selected surgical patients with a catheter in place postoperatively
Denominator Exclusions
Patients who had a urinary diversion, or a urethral catheter or were being intermittently catheterized prior to hospital arrival
Patients who expired perioperatively
Patients who expire before the end of (Post-Operative Day 2) POD 2 prior to catheter removal
Patients whose length of stay was less than two days postoperatively
Patients who had physician/APN/PA documentation of a reason for not removing the urinary catheter postoperatively
Patients who had a urological, gynecological or perineal procedure performed during inpatient encounter
Numerator
Number of surgical patients whose urinary catheter is removed on postoperative day (POD) 1 or postoperative day (POD) 2 with day of surgery being day zero
Numerator Exclusions
Not applicable
Denominator Exceptions
In ICU on POD 1 or POD 2 AND receives at least one dose(s) of one or more of the following medications:
     * Diuretic (oral or injectable)
     * IV Positive Inotropic and Vasopressor Agents 
     * Paralytic Agents (injectable)
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex

Table of Contents


Population Criteria

Data Criteria (QDM Variables)

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables


Measure Set
Surgical Care Improvement Project (SCIP)