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The use of the bladder scanner in the Older Person’s Health inpatient setting: does it help or hinder management?

A 2019/2020 Summer Studentship research project

  • Currently the Older Person’s Health department doesn’t have guidelines on use of the bladder scanner in the inpatient setting. The information obtained from this study may help to develop these.
  • To highlight awareness of bladder scanner use and utilise this information to educate staff around appropriate use of this tool.
  • Whether the information obtained by using the bladder scanner reduces urinary catheter insertion or encourages it. It is important to understand the factors that lead to the insertion of a urinary catheter in an older person, given the increased rates of infection associated with this intervention.

Student: Kelly Stewart
Supervisors: Dr Emma Losco, Mr Giovanni Losco
Sponsor: Canterbury Urology Research Trust

Introduction

A Bladder Scanner is readily available on the Older Person’s Health inpatient wards at Burwood Hospital. There are no clear guidelines around its use, but it is commonly used for indications such as but not limited to: assisting in the diagnosis of urinary retention, assessing progress after a urinary catheter is removed (a trial of void), assessing volume status of a patient, and assessing urinary incontinence. This simple investigation is available to both nursing and medical staff.

We know that urinary catheterisation increases rates of urinary tract infection, so it is best to restrict usage of urinary catheters to situations where they are clinically indicated. A urinary source is the most common cause of hospital acquired bacteraemia amongst older people in our DHB, so it is important that urinary disorders in older patients are managed correctly to try and reduce this risk. Some studies have shown that in the post-operative setting, the use of a bladder scanner can help to reduce unnecessary urinary catheterisation. It is also possible however that use of a bladder scanner may encourage interventions, such as an asymptomatic raised residual volume resulting in the insertion of a urinary catheter where there is no clinical indication. Therefore it is unclear in frail older inpatients whether use of the bladder scanner helps or hinders management of patients presenting with urinary symptoms such as difficulty voiding or urinary incontinence.

Aim

To understand the current use of the bladder scanner on the Older Person’s Health inpatient wards, specifically:

  • The reason the scan is undertaken
  • Who initiated the scan (nursing vs medical staff)
  • Whether the scan resulted in a new action for that patient, such as a change in their medication, insertion of a urinary catheter or referral for specialist input
  • How does this affect the long-term disposition of the patient: are they left with a catheter in situ? Does this generate a urological referral? What is the sequalae or morbidity of this?

Method

  • Prospectively collect all patients having a bladder scan on the inpatient Older Person’s Health wards at Burwood Hospital. These inpatients have a mixture of post-surgical, neurological and general medical problems, for which they are undergoing inpatient rehabilitation.
  • We plan to audit 100–150 uses of the bladder scanner
  • Audit the notes of these patients and record: demographics, the reason for the bladder scan, who initiated the scan, the scan result (volume in ml), and the action (if any) following the scan including changes to medications and/or the use of urinary catheters
  • Record the patient’s disposition and catheter status at six weeks post-discharge

Student researcher’s component of the study

  • The student will be given a list of patients on whom the bladder scanner has been used
  • They will be required to review the clinical notes including electronic documents such as discharge summaries and investigation results to collect the data
  • The student will then need to record the data, setting up appropriate spreadsheets to do so
  • The student will need to analyses the data, and will be given statistical support to do so

Student Prerequisites

Medical student

How to apply

Email emma.losco2@cdhb.health.nz