BladderScan^® Helps Dedicated Orthopedic Nursing Team Improve Patient Care

Life just became easier for patients recovering from total joint replacement surgery at Baystate Medical Center, thanks to Jane Fitzgerald, Ellen Starkey, and the other members of Baystate's dedicated nursing team. The team at Baystate recently eliminated routine post-surgical catheterization, an invasive procedure that increases patients' risk of infection, by incorporating the BladderScan into the daily regimen of care for patients in the orthopedic unit. Baystate Medical Center is a 579-bed hospital in Springfield, Massachusetts, which serves as the tertiary care referral center for Western Massachusetts. It is also a teaching and research facility, affiliated with Tufts University School of Medicine, Boston. The nursing staff at Baystate is exceptionally committed to improving the quality of patient care, as is evident from the initiative shown by the orthopedic nursing team.

Concerned about the risks associated with catheterizing patients recovering from total joint replacement surgery, Jane Fitzgerald, MS, RN, a clinical practice guideline coordinator, Ellen Starkey, RN, a clinical nurse on the Baystate orthopedic unit, and their colleagues recently conducted a six-week pilot study using the BladderScan in place of routine catheterization. The BladderScan is a device that noninvasively measures bladder volume using ultrasound. With knowledge of a patient's bladder volume, the Baystate nursing team can determine if catheterization is really necessary, rather than simply catheterizing the patient after a standard amount of time has elapsed. When the six-week study showed that the BladderScan improved patient comfort, reduced the cost of care by $15,000, saved nursing time, and prevented 171 unnecessary catheterizations, the team decided to adopt it as a standard part of post-operative care in their unit. As a result of the enterprise shown by Fitzgerald, Starkey, and their colleagues, many patients at Baystate are now being spared the experience of an unnecessary and invasive procedure that increases their risk of serious post-surgical complications.

Patients Thrilled by the Elimination of Routine Catheterization after Surgery

Before the introduction of the BladderScan, catheterization was just one more risky and unpleasant procedure that patients having joint-replacement surgeries had to bear. Not only were they catheterized during surgery, but they were also routinely catheterized afterwards if they were unable to urinate within six hours of the removal of the catheter placed during surgery. Patients must still be catheterized during surgery, since they receive epidural (spinal) anesthesia and temporarily lose the ability to void independently. However, with the introduction of the BladderScan, the second, post-surgical catheterization is seldom necessary. Rather than automatically catheterizing patients who are unable to void after surgery, the nurses at Baystate now use the BladderScanTM to noninvasively measure patients' bladder volume and determine whether catheterization is truly necessary. In most cases, it is not. During the six-week pilot study conducted by the Baystate nursing staff, only two out of forty-five patients required post-operative catheterization. Two patients who participated in the pilot study had experienced previous total joint replacement surgeries, during which they had been catheterized twice according to the old protocols. When recovering from their more recent surgeries, however, these patients avoided the second, post-surgical catheterization due to the introduction of the BladderScan. They both expressed relief at being spared the repetition of what one called "an unforgettable ordeal."

Catheterization is an Invasive Procedure which Increases Risk of Serious Complications

In addition to the physical discomfort it causes, catheterization is perceived by many patients as a shameful invasion of personal privacy. Catheterization also increases a patient's risk of developing a serious infection of the bladder or urinary tract. Jane Fitzgerald, MS, RN, noted that patients who have an indwelling catheter have a three to ten percent risk of developing a bladder infection. A patient's risk of infection increases the longer the catheter is left in place. According to Fitzgerald, of the patients who develop an infection from catheterization, "four percent will develop a blood infection and of those, thirteen percent will die from a hospital-acquired blood infection. Even with a brief catheterization of 24 hours the infection rate is one to five percent." In order to reduce this risk, patients who are catheterized post-operatively are given antibiotics to stave off potential infection. In the BladderScan, the nurses at Baystate have found an even more effective means of preventing infection. Fitzgerald explained, "The BladderScan means we don't cath a patient unless we're really sure they need it. This reduces potential infection and also the use of antibiotics."

Infection in people recovering from total joint replacement surgeries can have particularly serious consequences. An infection caused by catheterization can travel to the prosthesis (artificial joint); if the problem becomes severe enough, the patient's prosthesis must be removed. In consequence, the patient is left without a hip or a knee joint, and will be unable to walk. It can take up to a year for sufficient healing to occur so that surgery can be re-tried. These dangers were what motivated Fitzgerald, Starkey, and their colleagues at Baystate to seek an alternative to routine post-operative catheterization.

Nurses Enthusiastic about Improvements in Patient Care Resulting from BladderScan Use

The use of the BladderScan in the orthopedic unit minimizes the risk of serious infection and its attendant complications by eliminating unnecessary catheterizations. It also decreases the cost of care and the amount of nursing time required to deal with urological issues. During the pilot study at Baystate Medical Center, the nursing staff found that the BladderScan prevented 171 unnecessary catheterizations, saving $15,000 on staff time, antibiotic medication, and catheterization kits.

After witnessing the dramatic improvements in the quality of care that resulted from BladderScan use, Jane Fitzgerald, Ellen Starkey, and the other members of the nursing staff involved in the pilot study at Baystate Medical Center became enthusiastic advocates of ultrasound measurement of bladder volume. In order to make their colleagues aware of the benefits of the BladderScan, they presented a display of posters at the National Association of Orthopedic Nurses Annual Conference in Denver, Colorado, and at the Medical Surgical Nurses Annual Conference in Orlando, Florida. Ellen Starkey, RN, was so thrilled by the results of the pilot study that in June 2001 she funded her own trip to Anaheim to present a BladderScan poster at the annual meeting of the Society of Urological Nurses and Associates. The unusual dedication to improving patient care shown by Fitzgerald, Starkey, and their team is helping to make the benefits of the BladderScan available to patients both at Baystate and across the nation. Gerald McMorrow, Chairman of the Board and CEO of Verathon Inc. (formerly Diagnostic Ultrasound Corporation), the Bothell, WA-based company that produces the BladderScan, remarked, "The commitment of these nurses to improving the quality of patient care is exceptional. It is good to know that our product is helping dedicated nurses to make a difference in the lives of their patients."