Background:
The Yale New Haven Hospital adapted the Sunrise Clinical Manager (SCM) by Eclipse Corporation as its Electronic Medical Record (EMR) in 2007. The Hospitalist Service (HS) created a program extension that generated personalized daily worksheets for patient assignment in August 2008. Functionality was added to the worksheets by leveraging embedded SCM order filters to create a column identifying active Foley Catheter (FC) orders and day counts in December 2009 (Table.1) By using an integrated approach of using electronic daily reminders, education on best practices and by identifying a physician champion we were able to decrease foley catheter utilization by decreasing both the percentage of the census with foley catheter orders (16.6% to 11.27%) and the number of days the catheters were maintained (3.39 to 2.24 days). The hospital replaced SCM with the EPIC EMR in February 2013 creating an opportunity for a natural time interrupted series quasi‐experimental design protocol.
Methods:
A similar interface to generate daily worksheets was created for EPIC. The program is used to assign patients to a physician and a midlevel provider. Personalized worksheets are printed and distributed to providers daily. The columns which included daily reminders for foley catheters were not incorporated into the new worksheets. The comparison groups were defined as pre‐intervention (PRE), August 2012 to January 2013, and post‐intervention (POST), February 2013 to July 2013. FC utilization was defined via two metrics: (1) percentage of the daily census with an FC order (FC Ordering) and (2) number of days the catheter orders were maintained (FC Days).
Results:
There were 737 FC orders in 6365 unique discharges for the PRE group and 726 FC orders in 5690 discharges in the POST group. FC Ordering increased from the PRE 11.58 % to the POST 12.8% groups (Student t‐test, P<0.01). There was also an increase in FC Days, PRE 2.59 to POST 3.51 days (Student t‐test, P<0.01). This translates to 646 more foley catheter days, PRE 1903 vs POST 2549 days.
Conclusions:
An integrated approach to decrease foley catheter utilization is enhanced by the use of electronically generated reminders. We were able to create the enhanced worksheets for SCM and should be able to easily duplicate the intervention for any computerized EMR with little incremental cost to the system.
Worksheet Columns with Electronically Generated Daily Reminders
| Location | Patient | MR# | Provider | PMD | D/C | Central Line | VTEP | Foley | Telemetry |
| Bed | Name | Medical Record | MD or PA Assigned | Outpatient Care Provider | Discharge Status (R,Y,G) | Type, laterality Vessel, day count | Type, not indicated, none | FC Day Count | Telemetry Day Count |