When guidelines conflict: patient safety, quality of life, and CAUTI reduction in patients with spinal cord injury

The current Medicare payment structure and some of the recent guidelines aimed at reducing catheter-associated urinary tract infections may be generating a financial incentive for the protocolized, systematic removal of indwelling catheters in hospitalized patients—including those with spinal cord injury. This creates a tension with the Consortium for Spinal Cord Medicine’s clinical practice guidelines for the management of neurogenic bladder. This article presents a series of cases and a discussion of the implications with regard to patient safety and quality of life.