Refining Clinician Workflow as a Means to Improving Catheter Quality Measures

Abstract

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.