The Center for Disease Control and Prevention estimates that 1.7 million patients per year develop hospital-associated infections (HAI), of whom 99,000 die. HAIs financially impact the United States healthcare system with an estimated cost of $6 billion per year. At Platte Valley Medical Center (PVMC) in 2013, the urinary catheter utilization ratio and rates of catheter-associated urinary tract infections (CAUTI) were above the national average at 39% and 3.22 per 1000 urinary catheter days, respectively. Thus, we developed and piloted use of an electronic medical record (EMR) based patient safety checklist to reduce inappropriate device utilization and HAIs in patients hospitalized for acute illnesses.
Methods:
In February of 2014, the Sound Physicians Hospitalist organization deployed the catheter use and HAI patient safety checklist for hospitalists at PVMC. The EMR-based patient safety checklist included an education module, automated rounding alerts, active patient lists, daily patient reports, and routine performance reports. The safety checklist also provided indications for short term use and recommended removal of urinary and central line catheters. We tracked monthly urinary catheter and central line utilization ratios, and rates of CAUTIs and intensive care unit (ICU) catheter-associated blood stream infections (CLABSIs). We assessed performance of the patient safety checklist by comparing mean baseline data from 12 months before implementation (Jan to Dec of 2013) to 11 months after deployment of the checklist (Feb to Dec of 2014). Unpaired t-test methods were used for the analysis of utilization ratios and permutation tests were used to compare infection rates before and after use of the checklist.
Results:
This investigation included data from 2,365 urinary catheter device days, 806 central line days, and 6,910 total patient days to assess the performance of the device utilization and HAI patient safety checklist. We observed that urinary catheter utilization decreased by 11.6% after implementation of the patient safety checklist (p=0.026). Despite this, there was a non-significant increase of 19.3% in central line utilization (p=0.13). The rate of CAUTIs was found to have decreased from 3.2 per 1000 urinary catheter days (9/2799) to zero per 1000 urinary catheter days (0/2365) from before to after use of the patient safety checklist (p=0.009). There were no changes in the rate of CLABSIs in ICU patients (0 per 1000 central line-days).
Conclusions:
In this study, EMR based catheter utilization and hospital-associated infection patient safety checklist was associated with improvements in proper catheter use and decreased infection rates. Technology in conjunction with care team leaders for implementation of this checklist will enhance expansion to other hospitals and hospital systems, and has the potential to improve patient outcomes.