Background: Catheter Associated Urinary Tract Infections (CAUTI) and Central Line Associated Bloodstream Infections (CLABSI) carry a huge health care burden and is associated with increased length of stay and potential harm for the patient. There is an estimated total healthcare cost of $896 per infection for CAUTI and $45,814 per infection associated with CLABSI. The total annual cost of CAUTI and CLABSI are 0.28 billion and 1.85 billion dollars respectively.
Purpose: We present a simple cost-effective method to potentially decrease the risk of CAUTI and CLABSI in hospitals. We also use our two hospital campuses, with one serving as control, to conduct preliminary research.
Description: A “dotrphrase” is a few characters that the physician can type in the EMR to have a specific output in their note. The output can be lab values, tables or even sentences. In our case, we implemented a “dotphrase” in our Epic EMR by which physicians would automatically have the presence of foley and central line, and the number of days the foley and central line had been in place documented in their daily progress notes. The dotphrase was easy to use and was implemented as a part of the daily progress note, so that it auto populated within the note. A sample “dotphrase” is shown in Figure1.We hypothesized that the presence of the documentation in the notes would alert the physicians and nursing staff for the prompt removal of central lines and foley catheters. Since our hospital had two campuses, the dotphrase was only implemented in one campus and the data from the other campus was used as control.
Conclusions: In the CAUTI group, the average age of the patients where the dotphrase was used was 70±18.5(18-102), while the control group, where the dotphrase was not used, had an average age of 73±15.4(18-109). The percentage of females, who developed CAUTI, in the dotphrase group was 52.3% while in the control group 51% of the patients who developed CAUTI were females. The average BMIs were 49.2±9.2(14.1-85.6) and 47.0±7.3(16.2-92.1) in the dotphrase hospital and the non dotphrase hospital group respectively. In the CLABSI group, the mean ages of the patients were 43±13.1(18-92) in the dotphrase group and 40±10.8(18-91) in the non dotphrase group. 48.2% of the patients who developed a CLABSI in the hospital where dotphrase was used were female. On the other hand 55.6% of the patients who had a CLABSI in the hospital where dotphrase was not used were female. The average BMI of patients who had CLABSI were 35.1±11.1(15.8-67.4) and 39.5±9.3(13.2-72.1) in the hospital were dotphrase was used and in the hospital where dotphrase was not used respectively. Our results showed that the number of days foleys and central lines are left in patient significantly decreased with the use of the dotphrase. The dot phrase was implemented in December. The data collected from one month, three months and six months past the implementation of the dotphrase showed a significant reduction of central line days and foley days for patients when compared to the campus where the dotphrase was not used. There was however no significant decrease in the incident of CATUI and CLABSI, which maybe attributed to improper documentation. The data is shown in Figure2.Our study shows that having a documentation of the lines and foley in the progress notes might result in early removal of foleys and central lines. We highlight the cost-effectiveness and ease of implementation of our method as well. Further studies need to be done to validate the potential benefits of our method even further.
