Decreasing Urinary Catheterization in Kidney Injury (DUCKI): an effectiveness and deimplementation study in the Intensive Care Unit
Authors: Patten Calvin , Rosenzweig Tiffany E , Sona Carrie , Castro AC , Schmid Kristin , Walsh Maura , Robertson Laurie , Schallom Marilyn , Prentice Donna , Wessman Brian T , Ablordeppey Enyo A 
Published: January 2025

Funding

EAA is funded by the Washington University Department of Anesthesiology’s Division of Clinical and Translational Research (DoCTR). Research reported in this publication was supported by the Washington University Institute of Clinical and Translational Sciences grant UL1TR002345 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (1). The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.

KEY POINTS

This hybrid 1 implementation science study investigated the effectiveness of a program to reduce IUC utilization in ICU patients with AKI and ESRD. The DUCKI protocol successfully decreased IUC rates by 67% in the study’s targeted group of AKI and ESRD patients within an academic surgical ICU and was maintained over 2 years of follow up.

Using implementation science to introduce evidence-based strategies like DUCKI is effective at increasing adoption and sustaining the practice.

Oliguric patients offer a path of less resistance in changing catheterization practices.

DUCKI can safely minimize IUC use in specific ICU populations.

The protocol offers the potential for broader interventions to reduce catheter-associated risks in all ICU patients.

BACKGROUND

Indwelling urinary catheter use remains high in the surgical intensive care unit despite targeted, national efforts. When hospital-based initiatives occur, it is unclear if decreases in utilization are sustained.

OBJECTIVES

In 2021, we used implementation science to develop the Decreasing Urinary Catheters in Kidney Injury (DUCKI) program, targeting decreased indwelling catheterization in patients with acute kidney injury (AKI) with oliguria or end stage renal disease (ESRD). Three years later, we evaluated the effectiveness of DUCKI.

METHODS

This was a hybrid 1 implementation study. Outcomes of DUCKI eligible patients were evaluated through chart review with comparisons made between the 2021 and 2023 cohorts. Physicians and nurses were surveyed on the implementation effort.

RESULTS

∼12.5% of patients were eligible for DUCKI. 70 patients in 6 months in 2021 and 19 patients in month in 2023 met DUCKI criteria. The average indwelling catheterization rate in DUCKI patients dropped to 10% from 80% in 2021. In 2023, the catheterization rate in DUCKI patients remains low (9%). Overall rates in the unit declined from 74% pre-implementation to 70% in 2021 and 66% in 2023. There were no serious adverse events associated with the protocol. The acceptability survey was completed by ICU stakeholders pre (n=88) and post (n=77) intervention. Respondents generally rated DUCKI positively, although a minority (26%) reported increased burden to workflow.

CONCLUSIONS

Low indwelling catheterization rates in patients with oliguric AKI or ESRD were sustained in the ICU’s DUCKI implementation program. This program has contributed to sustained decrease in overall unit catheterization.