Measuring clinical information technology in the ICU setting: application in a quality improvement collaborative.
OBJECTIVE
Few instruments are available to measure the performance of intensive care unit (ICU) clinical information systems. Our objectives were: 1) to develop a survey-based metric that assesses the automation and usability of an ICU's clinical information system; 2) to determine whether higher scores on this instrument correlate with improved outcomes in a multi-institution quality improvement collaborative.


METHODS
This is a cross-sectional study of the medical directors of 19 Michigan ICUs participating in a state-wide quality improvement collaborative designed to reduce the rate of catheter-related blood stream infections (CRBSI). Respondents completed a survey assessing their ICU's information systems.


METHODS
The mean of 54 summed items on this instrument yields the clinical information technology (CIT) index, a global measure of the ICU's information system performance on a 100 point scale. The dependent variable in this study was the rate of CRBSI after the implementation of several evidence-based recommendations. A multivariable linear regression analysis was used to examine the relationship between the CIT score and the post-intervention CRBSI rates after adjustment for the pre-intervention rate.


RESULTS
In this cross-sectional analysis, we found that a 10 point increase in the CIT score is associated with 4.6 fewer catheter related infections per 1,000 central line days for ICUs who participate in the quality improvement intervention for 1 year (95% CI: 1.0 to 8.0).


CONCLUSIONS
This study presents a new instrument to examine ICU information system effectiveness. The results suggest that the presence of more sophisticated information systems was associated with greater reductions in the bloodstream infection rate.
Amarasingham
Ruben
R
Medicine Services, Parkland Health & Hospital System, Dallas, TX 75235, USA. ramara@parknet.pmh.org
Pronovost
Peter J
PJ
Diener-West
Marie
M
Goeschel
Christine
C
Dorman
Todd
T
Thiemann
David R
DR
Powe
Neil R
NR
D002404:Catheterization / Q000009:adverse effects; D003430:Cross-Sectional Studies; D006751:Hospital Information Systems / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration* / Q000592:standards; D008824:Michigan; D011785:Quality Assurance, Health Care; D018805:Sepsis / Q000517:prevention & control*; D011795:Surveys and Questionnaires