Clinical decision support (CDS) alerts reduce catheter-associated urinary tract infections, but simpler, redesigned ones can reduce them "dramatically," according to a new study in Infection Control and Hospital Epidemiology.
The researchers, from the Perelman School of Medicine at the University of Pennsylvania, evaluated 222,475 inpatient admissions from March 2009 to May 2012.
In the first phase of the study, the researchers reviewed the impact of the hospitals' stock alert that came with its electronic health record to help physicians assess when patients needed urinary catheters and then reassess their need when not removed within a recommended time period. In the second phase of the study, the hospitals used a quicker, simplified alert developed internally based on national Centers for Disease Control and Prevention guidelines.
The researchers found that the "off-the-shelf" alerts during the first phase caused 2 percent of the catheters to be removed when reassessed and that catheter-associated urinary tract infections dropped from 0.84 per 1,000 patient days to 0.70 per 1,000 patient days.
When the redesigned alerts were used in the second phase, the proportion of catheter removals increased more than seven-fold to 15 percent; catheter-associated urinary tract infections dropped to 0.50 per 1,000 patient days.
"Our study has two crucial, applicable findings," lead author Charles Baillie, an internal medicine specialist and fellow in the Center for Clinical Epidemiology and Biostatistics at Penn Medicine, said in an announcement. "First, electronic alerts do result in fewer catheter-associated urinary tract infections. Second, the design of the alerts is very important. By making the alert quicker and easier to use, we saw a dramatic increase in the number of catheters removed in patients who no longer needed them. Fewer catheters means fewer infections, fewer days in the hospital, and even, fewer deaths. Not to mention the dollars saved by the health system in general."
Other studies have found that EHR alerts, when designed well and used correctly, reduce provider errors and can significantly improve patient care. However, their current design and intrusiveness have been found to have a negative effect on patient safety.