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CC BY 4.0 · ACI open 2023; 07(02): e30-e40
DOI: 10.1055/s-0043-1771237
Research Article

Refining Clinician Workflow as a Means to Improving Catheter Quality Measures

Martina A. Clarke
1   School of Interdisciplinary Informatics, University of Nebraska–Omaha, Omaha, Nebraska, United States
2   Division of Cardiovascular Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Jana L. Wardian
3   Division of General Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States
,
Brandon S. Fleharty
4   Enterprise Clinical Applications, Nebraska Medicine, Omaha, Nebraska, United States
,
Craig G. Reha
5   Enterprise Practice Support, Nebraska Medicine, Omaha, Nebraska, United States
,
Justin R. Birge
3   Division of General Medicine, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, United States
› Author Affiliations Funding None declared.
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Abstract

Objective This study aimed to improve the quality measure performance for indwelling urinary catheter (IUC) duration, central venous catheter (CVC) duration, and telemetry duration by redesigning clinical decision support (CDS) tools within the documentation process and order workflow.

Methods The effectiveness of the redesign was evaluated using system standard quality reporting methodology to observe device duration, central-line-associated bloodstream infection (CLABSI) rate, and catheter-associated urinary tract infection (CAUTI) rate preintervention (FY2017) and postintervention (FY2018). Electronic health record (EHR) reporting tools were used to evaluate CDS alert data both preintervention and postintervention.

Results Total device duration and line days per patient days were reduced for CVC (12.8% [0.305–0.266]) and IUC (4.68% [0.171–0.163]). Mean telemetry duration was reduced by 16.94% (3.72–3.09 days), and CDS alert volume decreased 18.6% from a preintervention mean of 1.18 alerts per patient per day (81,190 total alerts) to a postintervention mean of 0.96 alerts per patient per day (61,899 total alerts). Both CLABSI (2.8% [1.07–1.04]) and CAUTI (8.1% [1.61–1.48]) rates were reduced, resulting in approximately $926,000 in savings.

Conclusion In this novel model, the redesigned CDS tools improved clinician response to CDS alerts, prompting providers to take action on relevant orders that automatically updated the clinical documentation to reflect their actions. The study demonstrated that effective redesign of CDS tools within the documentation process and order workflow can reduce device duration, improve patient outcomes, and decrease CDS alert volume.

Keywords

clinical decision support - alert fatigue - electronic health record - quality improvement

Protection of Human and Animal Subjects

As a quality improvement project, this evaluation does not constitute human subject research as defined at 45CFR46.102 - Subpart A: Basic U.S. Department of Health and Human Services Policy for Protection of Human Research Subjects. IRB approval was unnecessary. The authors have no conflict of interest.


Data Availability Statement

Due to commercial restrictions, data cannot be shared publicly, so supporting data are not available.




Publication History

Received: 20 April 2023

Accepted: 18 May 2023

Article published online:
18 July 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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