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

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

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).

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.

Infection control and hospital epidemiology. 2018 Jun 13 [Epub]

Brett E Youngerman, Hojjat Salmasian, Eileen J Carter, Michael L Loftus, Rimma Perotte, Barbara G Ross, E Yoko Furuya, Robert A Green, David K Vawdrey

1Department of Neurological Surgery,New York-Presbyterian Hospital Columbia University Medical Center,New York,New York., 2Data Science and Evaluation,Brigham and Women's Hospital,Boston,Massachusetts., 3School of Nursing,Columbia University,New York,New York., 5Department of Radiology,Weill Cornell Medical College,New York,New York., 6The Value Institute,New York-Presbyterian Hospital,New York,New York., 8Department of Infection Prevention and Control,New York-Presbyterian Hospital,New York,New York., 9Division of Emergency Medicine,Columbia University Medical Center,New York,New York.

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