Hostname: page-component-848d4c4894-cjp7w Total loading time: 0 Render date: 2024-06-19T04:45:48.644Z Has data issue: false hasContentIssue false
  • English
  • Français

Usability and Impact of a Computerized Clinical Decision Support Intervention Designed to Reduce Urinary Catheter Utilization and Catheter-Associated Urinary Tract Infections

Published online by Cambridge University Press:  10 May 2016

Charles A. Baillie ,
Mika Epps ,
Asaf Hanish ,
Neil O. Fishman ,
Benjamin French  and
Craig A. Umscheid
Charles A. Baillie*
Affiliation:
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Mika Epps
Affiliation:
Information Services, University of Pennsylvania Health System, Philadelphia, Pennsylvania; and Graduate School of Health Care Sciences, Tokyo Medical and Dental University, Tokyo, Japan
Asaf Hanish
Affiliation:
Department of Clinical Effectiveness and Quality Improvement, University of Pennsylvania Health System, Philadelphia, Pennsylvania
Neil O. Fishman
Affiliation:
Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania; and Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
Benjamin French
Affiliation:
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania
Craig A. Umscheid
Affiliation:
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania Center for Evidence-Based Practice, University of Pennsylvania Health System, Philadelphia, Pennsylvania; and Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania; and Institute for Translational Medicine and Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania
*
University of Pennsylvania, 3535 Market Street, Mezzanine, Suite 50, Philadelphia, PA 19104 (craig.umscheid@uphs.upenn.edu).
Get access Rights & Permissions [Opens in a new window]

Extract

Objective

To evaluate the usability and effectiveness of a computerized clinical decision support (CDS) intervention aimed at reducing the duration of urinary tract catheterizations.

Design

Retrospective cohort study.

Setting

Academic healthcare system.

Patients.

All adult patients admitted from March 2009 through May 2012.

Intervention.

A CDS intervention was integrated into a commercial electronic health record. Providers were prompted at order entry to specify the indication for urinary catheter insertion. On the basis of the indication chosen, providers were alerted to reassess the need for the urinary catheter if it was not removed within the recommended time. Three time periods were examined: baseline, after implementation of the first intervention (stock reminder), and after a second iteration (homegrown reminder). The primary endpoint was the usability of the intervention as measured by the proportion of reminders through which providers submitted a remove urinary catheter order. Secondary endpoints were the urinary catheter utilization ratio and the rate of hospital-acquired catheter-associated urinary tract infections (CAUTIs).

Result.

The first intervention displayed limited usability, with 2% of reminders resulting in a remove order. Usability improved to 15% with the revised reminder. The catheter utilization ratio declined over the 3 time periods (0.22, 0.20, and 0.19, respectively; P < .001), as did CAUTIs per 1,000 patient-days (0.84, 0.70, and 0.51, respectively; P < .001).

Conclusions

A urinary catheter removal reminder system was successfully integrated within a healthcare system’s electronic health record. The usability of the reminder was highly dependent on its user interface, with a homegrown version of the reminder resulting in higher impact than a stock reminder.

Infect Control Hosp Epidemiol 2014;35(9):1147-1155

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 9 , 01 September 2014 , pp. 1147 - 1155
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Saint, S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control 2000;28(1):68–75.Google Scholar
2. Tambyah, PA, Knasinski, V, Maki, DG. The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infect Control Hosp Epidemiol 2002;23(1):27–31. doi:10.1086/501964.Google Scholar
3. Klevens, RM, Edwards, JR, Richards, CL, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep 2007;122(2):160–166.Google Scholar
4. Umscheid, CA, Mitchell, MD, Doshi, JA, Agarwal, R, Williams, K, Brennan, PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infect Control Hosp Epidemiol 2011;32(2):101–114. doi:10.1086/657912.Google Scholar
5. Saint, S, Wiese, J, Amory, JK, et al. Are physicians aware of which of their patients have indwelling urinary catheters? Am J Med 2000;109(6):476–480.CrossRefGoogle ScholarPubMed
6. Meddings, J, Rogers, MAM, Macy, M, Saint, S. Systematic review and meta-analysis: reminder systems to reduce catheter-associated urinary tract infections and urinary catheter use in hospitalized patients. Clin Infect Dis 2010;51(5):550–560. doi:10.1086/655133.Google Scholar
7. Meddings, J, Rogers, MAM, Krein, SL, Fakih, MG, Olmsted, RN, Saint, S. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review. BMJ Qual Saf 2014;23(4):277–289. doi:10.1136/bmjqs-2012-001774.Google Scholar
8. Munasinghe, RL, Yazdani, H, Siddique, M, Hafeez, W. Appropriateness of use of indwelling urinary catheters in patients admitted to the medical service. Infect Control Hosp Epidemiol 2001;22(10):647–649. doi:10.1086/501837.Google Scholar
9. Saint, S, Kaufman, SR, Thompson, M, Rogers, MAM, Chenoweth, CE. A reminder reduces urinary catheterization in hospitalized patients. Jt Comm J Qual Patient Saf 2005;31(8):455–462.Google Scholar
10. Jain, P, Parada, JP, David, A, Smith, LG. Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Arch Intern Med 1995;155(13):1425–1429.Google Scholar
11. Bruminhent, J, Keegan, M, Lakhani, A, Roberts, IM, Passalacqua, J. Effectiveness of a simple intervention for prevention of catheter-associated urinary tract infections in a community teaching hospital. Am J Infect Control 2010;38(9):689–693. doi:10.1016/j.ajic.2010.05.028.Google Scholar
12. Loeb, M, Hunt, D, O’Halloran, K, Carusone, SC, Dafoe, N, Walter, SD. Stop orders to reduce inappropriate urinary catheterization in hospitalized patients: a randomized controlled trial. J Gen Intern Med 2008;23(6):816–820. doi:10.1007/s11606-008-0620-2.Google Scholar
13. Apisarnthanarak, A, Warren, DK, Fraser, VJ. The long-term outcome of a multifaceted intervention to reduce ventilator-associated pneumonia: can zero really be achieved? Am J Infect Control 2011;39(7):613–614. doi:10.1016/j.ajic.2010.11.010.Google Scholar
14. Huang, W-C, Wann, S-R, Lin, S-L, et al. Catheter-associated urinary tract infections in intensive care units can be reduced by prompting physicians to remove unnecessary catheters. Infect Control Hosp Epidemiol 2004;25(11):974–978. doi:10.1086/502329.Google Scholar
15. Fakih, MG, Dueweke, C, Meisner, S, et al. Effect of nurse-led multidisciplinary rounds on reducing the unnecessary use of urinary catheterization in hospitalized patients. Infect Control Hosp Epidemiol 2008;29(9):815–819. doi:10.1086/589584.Google Scholar
16. Crouzet, J, Bertrand, X, Venier, AG, Badoz, M, Husson, C, Talon, D. Control of the duration of urinary catheterization: impact on catheter-associated urinary tract infection. J Hosp Infect 2007;67(3):253–257. doi:10.1016/j.jhin.2007.08.014.Google Scholar
17. Cornia, PB, Amory, JK, Fraser, S, Saint, S, Lipsky, BA. Computer-based order entry decreases duration of indwelling urinary catheterization in hospitalized patients. Am J Med 2003;114(5):404–407.Google Scholar
18. Cresswell, K, Majeed, A, Bates, DW, Sheikh, A. Computerised decision support systems for healthcare professionals: an interpretative review. Inform Prim Care 2012;20(2):115–128.Google Scholar
19. Thursky, K. Use of computerized decision support systems to improve antibiotic prescribing. Expert Rev Anti Infect Ther 2006;4(3):491–507. doi:10.1586/14787210.4.3.491.Google Scholar
20. Horsky, J, Schiff, GD, Johnston, D, Mercincavage, L, Bell, D, Middleton, B. Interface design principles for usable decision support: a targeted review of best practices for clinical prescribing interventions. J Biomed Inform 2012;45(6):1202–1216. doi:10.1016/j.jbi.2012.09.002.Google Scholar
21. Bates, DW. Ten commandments for effective clinical decision support: making the practice of evidence-based medicine a reality. J Am Med Inform Assoc 2003;10(6):523–530. doi:10.1197/jamia.M1370a.Google Scholar
22. Phansalkar, S, Edworthy, J, Hellier, E, et al. A review of human factors principles for the design and implementation of medication safety alerts in clinical information systems. J Am Med Inform Assoc 2010;17(5):493–501. doi:10.1136/jamia.2010.005264.Google Scholar
23. University of Pennsylvania Health System Center for Evidence-Based Practice. http://www.uphs.upenn.edu/cep/.Google Scholar
24. Umscheid, CA, Williams, K, Brennan, PJ. Hospital-based comparative effectiveness centers: translating research into practice to improve the quality, safety and value of patient care. J Gen Intern Med 2010;25(12):1352–1355. doi:10.1007/s11606-010-1476-9.Google Scholar
25. Healthcare Infection Control Practices Advisory Committee. Atlanta: Centers for Disease Control and Prevention, 2013. http://www.cdc.gov/hicpac/. Accessed April 29, 2013.Google Scholar
26. Umscheid, CA, Agarwal, RK, Brennan, PJ; Healthcare Infection Control Practices Advisory Committee. Updating the guideline development methodology of the Healthcare Infection Control Practices Advisory Committee (HICPAC). Am J Infect Control 2010;38(4):264–273. doi:10.1016/j.ajic.2009.12.005.CrossRefGoogle ScholarPubMed
27. Gould, CV, Umscheid, CA, Agarwal, RK, Kuntz, G, Pegues, DA; Healthcare Infection Control Practices Advisory Committee. Guideline for prevention of catheter-associated urinary tract infections 2009. Infect Control Hosp Epidemiol 2010;31(4):319–326. doi:10.1086/651091.Google Scholar
28. Abookire, SA, Teich, JM, Sandige, H, et al. Improving allergy alerting in a computerized physician order entry system. Proc AMIA Symp 2000:2–6.Google Scholar
29. Dudeck, MA, Horan, TC, Peterson, KD, et al. National Healthcare Safety Network (NHSN) report, data summary for 2010, device-associated module. Am J Infect Control 2011;39(10):798–816.Google Scholar
30. Fakih, MG, Greene, MT, Kennedy, EH, et al. Introducing a population-based outcome measure to evaluate the effect of interventions to reduce catheter-associated urinary tract infection. Am J Infect Control 2012;40(4):359–364. doi:10.1016/j.ajic.2011.05.012.Google Scholar
31. Wright, M-O, Kharasch, M, Beaumont, JL, Peterson, LR, Robicsek, A. Reporting catheter-associated urinary tract infections: denominator matters. Infect Control Hosp Epidemiol 2011;32(7):635–640. doi:10.1086/660765.CrossRefGoogle ScholarPubMed
32. National Healthcare Safety Network. Atlanta: Centers for Disease Control and Prevention, 2013. http://www.cdc.gov/nhsn/. Accessed April 30, 2013.Google Scholar
33. Centers for Disease Control and Prevention (CDC). CDC/NHSN Surveillance Definition of Healthcare-Associated Infection and Criteria for Specific Types of Infections in the Acute Care Setting. Atlanta: CDC, 2013. http://www.cdc.gov/nhsn/PDFs/pscManual/pscManual_current.pdf. Accessed April 30, 2013.Google Scholar
34. French, B, Heagerty, PJ. Analysis of longitudinal data to evaluate a policy change. Stat Med 2008;27(24):5005–5025. doi:10.1002/sim.3340.Google Scholar
35. Knoll, BM, Wright, D, Ellingson, L, et al. Reduction of inappropriate urinary catheter use at a Veterans Affairs hospital through a multifaceted quality improvement project. Clin Infect Dis 2011;52(11):1283–1290. doi:10.1093/cid/cir188.Google Scholar
36. Glasgow, RE, Vogt, TM, Boles, SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Publ Health 1999;89(9):1322–1327.Google Scholar
37. Blumenthal, D. Stimulating the adoption of health information technology. N Engl J Med 2009;360(15):1477–1479. doi:10.1056/NEJMp0901592.Google Scholar