Urologic Procedure Pelvic Surgery PILOT - Algorithm for Early Removal of Urinary Catheters Applies to - Elective Total Hip Arthroplasty (May 15 – Jun 15 2017) EXCLUSION Criteria Urologic Procedure Pelvic Surgery Pre‐admission permanent indwelling catheter Bladder outlet obstruction (urology is consulted) Continuous bladder irrigation for gross hematuria Stage 3 or 4 sacral ulcer in incontinent female patient Comfort care, end of life Physician order for strict ins/outs Does the patient meet any of the EXCLUSION Criteria for leaving the urinary catheter in beyond POD #1 0600hr No Yes Remove urinary catheter Daily assessment of Urinary Catheter requirement Box 1 Re-assess patient in 4 hours Does the Pt. still require a Urinary Catheter? Box 2 Is Patient able to void? Bladder Scan Yes No Less than 400 mLs Greater than 400 mLs Assess causes for decrease in output. Encourage oral hydration. Re-assess in 2 hours Return to Box (2) Mobilize patient Does the patient have discomfort, urgency or incontinence? Does patient complain of Urgency or discomfort? Yes No Does Pt. complain of Urgency or discomfort? If 6 hrs has passed and patient has less than 400 mLs in bladder post, bladder scan and notify MRP Perform Bladder Scan Yes No In/Out Catheterization, then re-assess. Return to Box (1) Re-assess in 2 hours (perform bladder scan If volume greater than 600 mLs, perform in/out catheterization Re-assess in 2 hrs. Return to Box (2) If bladder scan 100-400 mLs re-assess next void Return to box (1) If bladder scan less than 100 mLs X 2 consecutive voids Discontinue Monitoring If In/Out Catheterization continues after 24 hrs, notify MRP