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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).
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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

Information

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.

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