SESSION TITLE: Cost and Quality Improvement
SESSION TYPE: Original Investigation Slide
PRESENTED ON: Tuesday, October 28, 2014 at 08:45 AM - 10:00 AM
PURPOSE: Catheter-Associated Urinary Tract Infection (CAUTI) as a quality metric has been recognized as labile and subject to wide variation. CAUTI rates in the Respiratory Care Unit (RCU) in the year of 2012 and 2013 have been one of the highest in our institution. We observed inconsistent use of paper checklists among health care providers, varied device utilization ratio (DUR), and knowledge gaps among providers regarding infection control efforts. We aimed to reduce urinary catheter days and DUR using a multidisciplinary team approach, a standardized electronic checklist, and visual reminders.
METHODS: The RCU at Mayo Clinic Rochester is a nine bed adult chronic ventilator unit with an average hospital stay of two weeks. We utilized DMAIC (Define, Measure, Analyze, Improve, and Control) as our quality improvement framework. Baseline data for catheter days and electronic checklist use were obtained for August and September of 2013. The intervention period was from November through December of 2013. Interventions performed included education to nursing staff about infection control and CAUTI data, an educational poster, reminder cards, and a portable tablet with internet access to complete the checklist. The checklist contained core measures for multiorgan systems including the genitourinary system. Education to nursing staff was in the form of lectures and an online educational module. Laminated reminder cards were posted on each patient’s door.
RESULTS: During the pre-intervention period, 37 patients were admitted to the RCU with a total of 107 urinary catheter days and 357 patient days, while in the post-intervention period, we observed 34 patients with 58 urinary catheter days and 274 patient days. The pre-intervention mean of catheter days per patient was 4.5 ± 3.33 days, as compared to the post-intervention mean of 3.2 ± 2.62 days (p=0.187). The DUR was decreased from 0.299 to 0.212. Electronic checklist compliance was significantly increased from 33% (119/357) to 95% (261/274) (p<0.0001) in the post-intervention period.
CONCLUSIONS: A combination of multidisciplinary teamwork, use of a standardized electronic checklist and constant visual reminders were effective. There was a trend toward significantly reducing the number of urinary catheter days and catheter utilization. Strategies targeted to these elements are essential to sustaining the project, thus minimizing the risk for CAUTI.
CLINICAL IMPLICATIONS: Urinary catheter days and utilization may be used as quality metrics to minimize CAUTI risk.
DISCLOSURE: The following authors have nothing to disclose: Rudy Tedja, Elizabeth Hassebroek, Perliveh Carrera, Lokendra Thakur, Cathy Mielke, Tammie Volkman, Libby Wyborny, Abby Christoffers, Jacquelyn Streiff, Nimpha Abcejo, Vicki Loeslie, Moua Teng
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