One of the SCIP protocols involves removing foley catheters post op within 48 hours to reduce hospital acquired urinary tract infections. UTI's acquired during a hospitalization, of course, are a "never event" and hospitals are loath to subject themselves to reimbursement penalties therein. One way to control this is to program the Electronic Medical Record (EMR) for Physician Order Entry (POE) such that all foley catheters are automatically removed by post op day #2 no matter if the surgeon wants it or not. By making foley removal the default pathway, you improve foley removal rates and, presumably, lower rates of acquired UTI's. The doctor is removed from the decision-making process altogether.
My partner operated on someone with an incarcerated hernia not too long ago. The patient was an older guy and he had to perform a limited bowel resection. A foley was placed prior to incision. The guy had a history of severe BPH and it was a struggle to get the catheter in. In his post-op orders he checked the standard box on the POE for Foley care (usually a bag to free gravity).
Unbeknownst to him, the "Foley care" order contained a drop-down box (accessible by clicking a separate tab) mandating that the catheter was to be removed on post-op day #2. In the evening of post op day #2, my partner received a phone call from the nurse---your patient hasn't been able to void since the catheter came out.
"Why is it out? I never wrote that. The guy has a prostate the size of a tennis ball."
"I don't know doctor. But he's having a lot of pain. The lasix you wrote for worked though. The bladder scanner says he's retained 700cc of urine."
And of course the house officer couldn't get the Foley in. Urology had to be consulted, urgently. The guy ended up getting another catheter placed, this time without the benefit of deep anesthesia. According to one of the nurses on that night, it took about 30 minutes of penis stabbing to get it in. But at least the hospital's SCIP data will look good.