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
