Acute urinary retention in a district general hospital: an observational study
Background: Our district general hospital sees an average of 102,000 acute emergency attendances a year. Acute Urinary Retention (AUR) is a common and distressing medical emergency presenting with painful inability to pass urine which can be relieved by catheterisation.
Objective: The objective of this observational study was to assess and audit the management of AUR in the emergency department (ED) against Royal College of Emergency Medicine (RCEM) clinical standards.
Method:
This retrospective study was carried out over a six months period from July 2016 to early January 2017. Data was obtained from electronic records and patients’ notes.
Results:
In the 52 adult participant patients, the mean age was 71 and median 73 years. Upon arrival 12% received analgesia and only 38% were catheterised within one hour of arrival. Initial catheterisation was done mainly by any available doctor and a few trained nurses. However, by the second hour only 64% had been catheterised. Altogether 72% received a urethral catheter and 68% appropriately received antibiotics. While 85% had residual urine documented, only 15% had their renal function tests documented. 94% had outpatient follow up or specialty (urology) review in accordance with local policy upon leaving the department.
Discussion and Conclusion:
This single centre, retrospective study demonstrates a snap shot of the challenges of managing AUR at a district general hospital. Our department has since then embarked on shared learning events (meetings and e-mail) on the study results to highlight the relevance of early intervention (analgesia and catheterisation) and introduced a departmental protocol. On-going education and training is required to maintain reasonably good clinical standards of care.
