Why Are 21st Century Hospitals Monitoring Kidney Function with 1930s Technology?
“Measure what?”
It was a clarifying question. As I stood by the hospital nurse manager, I was prepared to explore any request that would make nurses’ lives easier. I was the hospital system’s head of enterprise innovation and knew that clinical teams were overburdened with their everyday workload, documentation, and increasing demands. Nationwide, the nurse-to-patient ratio was increasing, contributing to burnout and concerns for patient safety. Still, the request was an unexpected one.
“Urine.” She motioned in the direction of a patient’s hanging catheter. “There has to be an easier way to monitor, measure, and manage urine output and the kidneys.”
I heard, and understood, the problem. Catheters weren’t foremost in my mind, but I knew how they worked. Though used by 15-25% patients during their hospital stay, the technology wasn’t automatic and the workflow wasn’t easy. It was an aspect of care that demanded innovation.
Urine output is a vital sign of overall kidney function, so facilitating fluid management and keeping kidneys healthy is vital for hospital patients and their care teams. But while advances had been made to monitor our hearts, brains, and lungs for better preventative care, kidneys had been left to a manual and time-consuming process – one that was originally patented in 1936. You can make your own analogies, but how about trying to race a 1936 Maserati against a 2025 model? Our hospital’s – and every hospital’s – antiquated race car wasn’t serving patients and nurses well. The stubborn incidence of acute kidney injury (AKI) in post-operative hospital patients, a condition that contributes to 300,000 deaths annually, results in part from the prevalence of old technology.
The 1936 Foley catheter is the most widely used technology for draining a patient’s bladder following surgery or intensive care unit (ICU) procedures, with more than 30 million sold in the U.S. annually. Due to its design that relies on gravity to collect fluid, the Foley catheter can lead to inconsistent tracking for nurses, who need to tackle up to 125 tasks per hour. Beyond that, the traditional catheter doesn’t show the whole picture – or even the right one.
A catheter is inserted in a patient before surgery, such as a cardiac procedure, and remains there as the patient recovers in the ICU. Even if nurses had all the time in the world to manually clear urine from tubes and measure the urine output every hour, the data gained from the catheter still couldn’t be guaranteed to be accurate due to its limited technology. When blockages occur, due to twisted tubes or urine samples becoming contaminated, doctors don’t have a full data picture. The patient, whose heart procedure was successful, could leave the hospital without even realizing their kidneys have been compromised due to a hospital-acquired infection that could take up to seven days to develop
AKI is a common hospital acquired injury, affecting 42% of patients admitted to the ICU which increases the risk for length of hospital stay – with associated costs up to $69,000 per patient – and can cause chronic conditions.
All of this goes back to the hospital floor, standing with the nurse manager and wondering if a technology even existed to modernize kidney monitoring and improve patients’ health. I wasn’t sure – but what was clear was the need for a transformational solution to help clinical teams more easily monitor, manage, and measure kidney performance. After spending many hours in the ORs and ICUs, I knew a solution needed to:
- Automating urine output: Infections and blockages can come from improper draining of catheters. By automating the drainage system, the risk of issues would plummet.
- Real-time monitoring: In the same way we have tools to more accurately measure a patient’s heart rate or blood pressure, reliable and improved methods would do the same for the kidneys.
- Workflow: First and foremost, we needed a design to support nurses. If innovation didn’t fit into their workflow or make their job easier, it wouldn’t be innovation. Catheters need to provide standard-driven, objective, reliable, and accurate information regarding kidney performance.
Many years later, after discovering the technology they were looking for, I returned to the hospital and saw nurses had pinned a note to one of the new, automated smart catheters that read: “Do Not Remove from the CTICU.” It was clear this innovation had improved nurses’ ability to do their jobs. More than 110,000 of the new catheter-and-sensor systems have been used across the U.S. It’s a fraction of the established method, but it represents the potential for transforming kidney health in this country.
My conversation with the nurse manager was a call to do better. Hospitals are inundated with thousands of competing priorities and staffing shortages. When technology can make an immediate difference for something as important as kidney health, we need to act.
Photo: Urupong, Getty Images
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