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. 2014 Sep;35(9):1147-55.
doi: 10.1086/677630. Epub 2014 Jul 25.

Usability and impact of a computerized clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections

Charles A Baillie  1 , Mika Epps, Asaf Hanish, Neil O Fishman, Benjamin French, Craig A Umscheid
Affiliations

Usability and impact of a computerized clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections

Charles A Baillie et al. Infect Control Hosp Epidemiol. 2014 Sep.

Abstract

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.

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Conflict of interest statement

Conflict of interest. The authors reports no potential financial conflicts of interest relevant to this article.

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References

    1. Saint S. Clinical and economic consequences of nosocomial catheter-related bacteriuria. Am J Infect Control. 2000;28(1):68–75. - PubMed
    1. Tambyah PA, Knasinski V, Maki DG. The direct costs of nosocomial catheter-associated urinary tract infection in the era of managed care. Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America. 2002;23(1):27–31. doi: 10.1086/501964. - DOI - PubMed
    1. Klevens RM, Edwards JR, Richards CL, et al. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007;122(2):160–166. - PMC - PubMed
    1. Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the proportion of healthcare-associated infections that are reasonably preventable and the related mortality and costs. Infection control and hospital epidemiology : the official journal of the Society of Hospital Epidemiologists of America. 2011;32(2):101–114. doi: 10.1086/657912. - DOI - PubMed
    1. Saint S, Wiese J, Amory JK, et al. Are physicians aware of which of their patients have indwelling urinary catheters? Am J Med. 2000;109(6):476–480. - PubMed

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