A new VHA case study whitepaper released today by Medline Industries, Inc. details how the company used observational studies and context-based design to build human factors and social behaviors into its redesigned Foley Catheter Management tray.

The whitepaper, Social Practice and Clinicians' Meaning of Urinary Catheter Insertions, showed that the redesigned tray significantly influenced the clinician's ability to provide high quality care by creating a greater focus on providing patient comfort, maintaining sterile technique and decreasing the time of the entire insertion process. The observational study was comprised of three separate three-day observations of clinicians conducting catheterizations in the emergency department, medical/surgical floors and operating rooms at Providence Sacred Heart Medical Center and Children's Hospital, Spokane, WA.

"Health care manufacturers are often overlooked when clinicians redesign clinical practices. Yet, the design of a product can be key to helping clinicians improve clinical performance and patient education," said Trent Haywood, MD, JD, Senior Vice President of Clinical Performance and Chief Medical Officer for VHA and lead investigator. "For example, Medline chose to redesign the urinary catheter tray based upon the observational data uncovered in the clinical setting. Such design emphasis shows how manufacturers can be a key partner in quality and safety."

The unique partnership between Medline and the VHA research team highlights how industry vendors can partner with healthcare providers to develop a comprehensive system that incorporates proper procedures and social behaviors that are easy to adopt in everyday practice.

Medline launched its ERASE CAUTI program, which is based on the same criteria the CDC used in developing their new CAUTI prevention guidelines, last fall. Soon after the tray's introduction, Medline met with the VHA Clinical Performance team to discuss studying the tray and how it's used in actual clinical practice. Emphasis was put on understanding the objectives of catheter insertions from the clinician's perspective, clarifying the actual practice that unfolds and identifying areas where the catheter management system aided the clinician or failed to aid the clinician based upon the clinician's perspective on the practice.

Findings summarized in a case study whitepaper showed that clinicians preferred the benefits of the single layer tray which did not require steps related to maneuvering and positioning with a two layer tray. They also preferred the change to swab sticks that decreased the number of steps in the prepping and cleansing of the perineum. Clinicians retained the patent-pending patient education card for the patient or placed it in location where the patient might review it -- a departure from previously observed behavior where the education was discarded without much attention. Clinicians also used the full-colored photography packaging to better explain the procedure to patients.

"Chief Nursing Officers (CNOs) want to help their staff reduce variability in the procedures that are done so that the potential to make an error decreases," said Connie Yuska, Medline's Vice President of Clinical Services and a former CNO. "We redesigned the tray taking into account the interaction between the patient and the clinician and facilitate learning -- things that challenge nursing leaders every day."