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Reducing indwelling urinary catheter use through staged introduction of electronic clinical decision support in a multicenter hospital system

Published online by Cambridge University Press:  13 June 2018

Brett E. Youngerman Open the ORCID record for Brett E. Youngerman [Opens in a new window] ,
Hojjat Salmasian Open the ORCID record for Hojjat Salmasian [Opens in a new window] ,
Eileen J. Carter ,
Michael L. Loftus ,
Rimma Perotte ,
Barbara G. Ross ,
E. Yoko Furuya ,
Robert A. Green  and
David K. Vawdrey
Brett E. Youngerman*
Affiliation:
Department of Neurological Surgery, New York-Presbyterian Hospital Columbia University Medical Center, New York, New York
Hojjat Salmasian
Affiliation:
Data Science and Evaluation, Brigham and Women’s Hospital, Boston, Massachusetts
Eileen J. Carter
Affiliation:
School of Nursing, Columbia University, New York, New York Department of Nursing, New York-Presbyterian Hospital, New York, New York
Michael L. Loftus
Affiliation:
Department of Radiology, Weill Cornell Medical College, New York, New York
Rimma Perotte
Affiliation:
The Value Institute, New York-Presbyterian Hospital, New York, New York Department of Biomedical Informatics, Columbia University, New York, New York
Barbara G. Ross
Affiliation:
Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, New York
E. Yoko Furuya
Affiliation:
Department of Infection Prevention and Control, New York-Presbyterian Hospital, New York, New York
Robert A. Green
Affiliation:
Division of Emergency Medicine, Columbia University Medical Center, New York, New York Department of Quality and Patient Safety, New York-Presbyterian Hospital, New York, New York
David K. Vawdrey
Affiliation:
The Value Institute, New York-Presbyterian Hospital, New York, New York Department of Biomedical Informatics, Columbia University, New York, New York
*
Author for correspondence: Brett E. Youngerman, Department of Neurological Surgery, Columbia University Medical Center, 710 West 168 Street, New York, NY, 10032. E-mail: bey2103@cumc.columbia.edu
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Abstract

Objective

To integrate electronic clinical decision support tools into clinical practice and to evaluate the impact on indwelling urinary catheter (IUC) use and catheter-associated urinary tract infections (CAUTIs).

Design, Setting, and Participants

This 4-phase observational study included all inpatients at a multicampus, academic medical center between 2011 and 2015.

Interventions

Phase 1 comprised best practices training and standardization of electronic documentation. Phase 2 comprised real-time electronic tracking of IUC duration. In phase 3, a triggered alert reminded clinicians of IUC duration. In phase 4, a new IUC order (1) introduced automated order expiration and (2) required consideration of alternatives and selection of an appropriate indication.

Results

Overall, 2,121 CAUTIs, 179,070 new catheters, 643,055 catheter days, and 2,186 reinsertions occurred in 3·85 million hospitalized patient days during the study period. The CAUTI rate per 10,000 patient days decreased incrementally in each phase from 9·06 in phase 1 to 1·65 in phase 4 (relative risk [RR], 0·182; 95% confidence interval [CI], 0·153–0·216; P<·001). New catheters per 1,000 patient days declined from 53·4 in phase 1 to 39·5 in phase 4 (RR, 0·740; 95% CI, 0·730; P<·001), and catheter days per 1,000 patient days decreased from 194·5 in phase 1 to 140·7 in phase 4 (RR, 0·723; 95% CI, 0·719–0·728; P<·001). The reinsertion rate declined from 3·66% in phase 1 to 3·25% in phase 4 (RR, 0·894; 95% CI, 0·834–0·959; P=·0017).

Conclusions

The phased introduction of decision support tools was associated with progressive declines in new catheters, total catheter days, and CAUTIs. Clinical decision support tools offer a viable and scalable intervention to target hospital-wide IUC use and hold promise for other quality improvement initiatives.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 8 , August 2018 , pp. 902 - 908
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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