Natalie Pageler, MD, MEd
Stanford Hospital and Clinics
Hypothesis: This study was designed to test the hypothesis that an EMR-enhanced checklist in conjunction with an electronic patient safety and quality dashboard would be associated with improved compliance with evidenced-based guidelines for the prevention of CABSI in a PICU. The secondary hypothesis was that utilization of an EMR-enhanced checklist with built-in links to relevant educational materials will improve the perception of knowledge about evidence –based guidelines for the prevention of CABSI.
Methods: A cohort study with historical controls was performed that included all patients with a central venous catheter in a 24-bed pediatric intensive care unit (PICU) in an academic children’s hospital. Post-intervention CABSI rates, compliance with bundle elements, and staff knowledge and perceptions of communication were evaluated and compared with pre-intervention data.
Results: CABSI rates decreased from 2.6 CABSIs per 1000 line days pre-intervention to 0.7 CABSIs per 1000 line days post-intervention. Analysis of specific bundle elements demonstrated: 1) increased daily documentation of line necessity from 30% to 73% (p < 0.001); 2) increased compliance with dressing changes from 87% to 90% (p = 0.003); 3) increased compliance with cap changes from 87% to 93% (p < 0.001); 4) increased compliance with port needle changes from 69% to 95% (p < 0.001); but 5) decreased compliance with insertion bundle documentation from 67% to 62% (p = 0.001). Changes in the care plan were made during review of the EMR checklist on 39% of patient rounds episodes. There was an increased perception of discussion of line necessity
Conclusions: Use of an EMR-enhanced CABSI prevention checklist coupled with a unit-wide real-time display of adherence was associated with increased compliance with evidence-based catheter care and sustained decrease in CABSI rates. These data underscore the potential for informatics-enabled interventions to promote compliance with proven best practices and prevent patient harm.
