21 December 2022

Tower Hamlets EPCT Team: using Pareto Analysis to understand the problem “To reduce avoidable callouts for catheter problems”

By Georgina Amparado-Molina (Locality Lead for the EPCT Tower Hamlets and a QI Coach) and Carlos Santos (Improvement Advisor for ELFT Corporate Services).



In mid-2022, the Tower Hamlets Enhanced Primary Care Team (TH EPCT) identified the high volume of patients’ callouts due to catheter blockages (Figure 1) as a concern for both patient well-being and staff capacity


Figure 1 – Number of daily callouts for catheter-related support


The team suspected that this issue was related to the number of avoidable callouts occurring due to treatment-related factors, such as medication or physical health status, and believed that targeting the reasons for these would reduce blockages. However, given that multiple issues can contribute to unwanted outcomes, it can be challenging to identify which play a key role. The TH EPCT decided to use the powerful Pareto Chart tool, based on the Pareto Principle, to better identify and understand which issues contributed most to callouts and therefore which to focus in on.

The Pareto Principle (or 80/20 rule) suggests that 80% of outcomes will come from 20% of the influences in a system; concurrently, it suggests that when analysing the main causes of a complex problem, its often possible to separate “the vital few” factors that are contributing most to the problem, compared to factors that have less influence.

The TH EPCT team analysed all the reasons given for catheter blockage callouts from June to August 2022, recording the frequency of each callout issue, listing these in the tabular format below:


Frequency of each callout issue


They then used a pareto chart (fig 2) to analyse the results, finding that an astounding 83.9% of callouts were due to the catheter type, as opposed to any of the other issues. A particular catheter type (there are 3 types available) was leading to a mechanical dysfunction with the drainage system. This was surprising to some team members, who suspected that most blockage issues were primarily related to other causes such as clients not having enough fluid intake, or their current medication eventually leading to constipation or other related physical health causes.


Figure 2 – Pareto Analysis of the reasons for catheter blockages at TH EPCT during June-August 2022. For more information on how to create a pareto chart, click here.

What’s Next

With such key information around frequency of causes, the team started tackling what appeared to be the most recurrent reason for the catheter blockage callouts, rather than assuming callouts were purely related to other issues such as medication reviews or patient lifestyles. Such is the power of information when linked in with an improvement approach. The Project Lead met with the continence nurse specialist, who agreed to test another type of catheter being utilised in the community. This will allow the team to test whether the new product will result in a reduction of the high volume of patients’ callouts due to catheter blockages.



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