Electronic Alerts in EHRs Reduce Urinary Tract Infections (Study – US)

According to the World Health Organisation, urinary tract infections (UTIs) win top prize for most frequent health care-associated infection in high-income countries. And the cause?…A massive 75% of all of hospital acquired UTIs result from having a urinary catheter fitted (i.e. a tube inserted into the bladder through the urethra to drain urine). And it’s far from unusual to have this procedure done, for between 15 to 25 percent of hospitalized patients have one fitted during their hospital stay (Source CDC). Having a urinary tract infection can be nasty enough but if left untreated serious consequences can result including permanent kidney damage.

The most effective way to reduce the incidence of UTIs (apart from not having a catheter fitted in the first place) is by removing the catheter as soon as it is no longer needed. Unfortunately, all too often this does not happen. That’s why the findings from this new study from the University of Pennsylvania are significant. Results showed that automated alerts in Electronic Health Records (EHRs) reduced urinary tract infections in hospital patients with urinary catheters.

The EHR alert system worked by prompting physicians to specify the reason for inserting the patient’s catheter. On the basis of the reason selected, the system then helped them decide (a) whether urinary catheters were needed in the first place and (b) alerted them to reassess the need for catheters that had not been removed within a recommended time period. And it was no small-fry study. The research took place over three years and was conducted among 222,475 inpatient admissions to three hospitals of the University of Pennsylvania Health System.

A further significant finding from the research was that simplifying the system for physicians dramatically decreased the rate of infection. For instance, among other improvements the simplified system required two mouse clicks from physicians to submit a remove-urinary-catheter order, compared to seven mouse clicks required by the original alert. Who would have guessed what a difference five clicks could make! But it’s an important point and one that’s often overlooked; the usability of any system from the standpoint of the user (in this case the physician) can dramatically increase its impact.

The study will be published in the September issue of Infection Control and Hospital Epidemiology. Penn Study News Release

[Updated] Editors Note: I just came across an interesting piece in the New York Review of Books called ‘On Breaking One’s Neck’ (Published Feb 2014) by Arnold Relman, Professor Emeritus of Medicine and Social Medicine at Harvard Medical School and a senior physician with over six decades of experience. Mr Relman who is sadly now deceased, fell down the stairs of his home ten days after his ninetieth birthday. As well as writing about the impact the fall had on him and his recovery, he  stated, ‘I am also convinced that other factors contributed to my survival… my medical training helped. It made me aware of the dangers of pneumonia and other infections from contamination of catheters and tubes, so I pushed to have the latter removed as soon as possible and I took as few sedatives and painkillers as possible.’ RIP Mr Relman.

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