Electronic Health Records

Adoption & Implementation News

Study: Better EHR alerts could reduce 70% of inpatient UTIs

By Jennifer Bresnick

A simplified EHR alert that encourages infection control measures could reduce the number of urinary tract infections (UTIs) in hospitalized patients by up to 70 percent, resulting in 380,000 fewer infections and saving 9000 lives per year, says a study from the University of Pennsylvania.  By redesigning the standard patient safety alert to reduce the number of necessary clicks from seven to two, clinicians removed seven times as many unnecessary catheters and decreased the rate of catheter-associated infections by .20 per 1000 patient-days.

“Our study has two crucial, applicable findings,” said the Penn study’s lead author Charles A. Baillie, MD, an internal medicine specialist and fellow in the Center for Clinical Epidemiology and Biostatistics at Penn Medicine. “First, electronic alerts do result in fewer catheter-associated urinary tract infections. Second, the design of the alerts is very important. By making the alert quicker and easier to use, we saw a dramatic increase in the number of catheters removed in patients who no longer needed them. Fewer catheters means fewer infections, fewer days in the hospital, and even, fewer deaths. Not to mention the dollars saved by the health system in general.”

The study involved more than 222,000 patients admitted to UPenn’s three hospitals between 2009 and 2012.  Clinicians were prompted to enter the reason for catheterization into the EHR at the time of the procedure.  The software then triggered an alert at the end of the recommended time period for catheter use based on the condition reminded the physician to reevaluate the need for the device or remove it entirely.

The EHR’s out-of-the-box patient safety features, which required a series of interactions with the software, were still able to reduce the UTI rate from .84 per 1000 patient-days to .70 per 1000 patient-days.  The simplified alerts further cut the infection rate from .70 to .50 per 1000 patient days, the study found.  With up to a quarter of admitted patients receiving urinary catheters during their stay, the improvements in timely removal or reevaluation add up to significant changes in the way patients experience care.

“As more hospitals adopt electronic health records, studies such as ours can help point the way toward improved patient care,” said senior author Craig Umscheid, MD, MSCE, assistant professor of Medicine and Epidemiology and director of Penn’s Center for Evidence-based Practice. “Thoughtful development and deployment of technology solutions really can make a difference. In this study, we learned that no two alerts are alike, and that changes to an alert’s usability can dramatically increase its impact.”

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