Electronic Checklist Linked to 3-fold Drop in CLABSIs

Marcia Frellick

February 24, 2014

An automated checklist that pulls information from electronic medical records and sends alerts to clinicians has been linked with a 3-fold decrease in a serious type of hospital-acquired infection at a California pediatric intensive care unit (PICU).

In the study, Natalie M. Pageler, MD, from the Center for Excellence in Pulmonary Biology, the Divisions of Pulmonary, Asthma, and Critical Care Medicine, Stanford University Medical School, and the Department of Clinical Informatics, Lucile Packard Children’s Hospital at Stanford, California, and colleagues targeted central line-associated bloodstream infections (CLABSIs), a highly preventable cause of illness and death that hospitals everywhere are trying to reduce. They present their findings in an article published online February 24 in Pediatrics.

Color-Coded Status Alerts

The team developed a computer program that links relevant best practice bundles with individual patient's electronic health records. The program alerts physicians and nurses when central lines are due for care and a connected interactive dashboard displays patients' status easily and quickly as clinicians make rounds. The checklist also links to educational and institutional information to help clinicians in their decision-making process.

A nurse, for example, could see in real time on a large screen a color-coded dot next to a patient's name if a central line dressing needed to be changed or if it were time for caregivers to reevaluate whether medications given through the central line could be switched to oral formulations.

The CLABSI rate in the PICU dropped from 2.6 per 1000 line-days (19 CLABSIs/7322 total line-days) before intervention (June 2009 - April 30, 2011) to 0.7 CLABSIs per 1000 line-days (7 CLABSIs/6155 total line-days) after implementation (September 1, 2011 - December 31, 2012).

The authors found increased compliance on individual elements of care with the checklist, including daily documentation of central line necessity (from 30% before implementation to 73% after; P < .001), dressing change (from 87% to 90%; P = .003), and port needle changes (from 69% to 95%; P < .001). However, compliance dropped in terms of insertion bundle documentation, going from 67% to 62% (P = .001).

Broader Uses Possible

Although the research focused on the PICU, the intervention would translate well to other settings and adult populations as well, said senior author Deborah Franzon, MD, a clinical associate professor of pediatrics at Stanford and medical director of the hospital's PICU.

She told Medscape Medical News that this checklist would translate well for the prevention of other complications, including pressure ulcers or ventilator-associated pneumonia. The success of this checklist lies in its ability to pull out key information from the patient's record and analyze that against best practices for central line care.

"Instead of having to hunt for information that's challenging to find in the chart, it brought that information forward," Dr. Franzon said.

An inherent feature of a checklist integrated in the electronic health record is that it can also document compliance. In addition to alerting that a dressing needs to be changed, for instance, the system can document how fast it was changed, she said.

Financial Benefit

The researchers note that in addition to avoiding harm to patients, the checklist would provide an estimated cost savings of approximately $260,000 per year. Treating a single CLABSI costs about $39,000, they said.

Even though many interventions have been found to reduce CLABSIs, implementing them is often difficult because of the large volume of tasks that must be completed for critically ill patients throughout the day.

The benefit of the automated checklist is that it handles some of the care team's safety check tasks, freeing clinicians up for more direct patient care.

This study was supported by the Lucile Packard Foundation for Children's Health and the Child Health Research Institute Innovations in Patient Care Program, the Stanford National Institutes of Health Clinical and Translational Science Award, and an HP Sustainability and Social Innovation grant. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online February 24, 2014.


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