title: Electronic documentation of central venous catheter-days: validation is essential.
abstract: BACKGROUND
  Measurement of central line-associated bloodstream infection (CLABSI) rates outside of intensive care units is challenged by the difficulty in reliably determining central venous catheter (CVC) use. The National Healthcare Safety Network (NHSN) allows for use of electronic data for determination of CVC-days, but validation of electronic data has not been studied systematically.
  
  
  OBJECTIVE
  To design and validate a process to reliably measure CVC-days outside of the intensive care units that leverages electronic documentation.
  
  
  METHODS
  Thirty-four inpatient wards at 2 academic hospitals using a common electronic platform for nursing documentation were studied. Electronic queries were created to capture patient and CVC information, and tools and processes for tracking and reporting errors in documentation were developed. Strategies to validate electronic data included comparisons with manual CVC-day determinations and automated data validation using customized tools. Interventions included redesign of documentation interface, real-time audit with feedback of errors, and education. The primary outcome was patient-level total error rate in electronic CVC-day measurement compared with manually counted CVC-days.
  
  
  RESULTS
  At baseline, there were a mean (± standard deviation) of [Formula: see text] electronic CVC-day errors (omission and commission errors summed and counted equally) per manually counted CVC-day. After several process improvement cycles over 7 months, the error rate decreased to <0.05 errors per CVC-day and remained at or below this level for 2 years.
  
  
  CONCLUSIONS
  Baseline electronic CVC-day counts had a high error rate. Stepwise interventions reduced errors to consistently low levels. Validation of electronic calculation of CVC-days is essential to ensure accuracy, particularly if these data will be used for interinstitutional comparison.
authors.affiliation: Division of Hospital Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia 30329, USA. scherne@emory.edu
authors.forename: Sheri Chernetsky
authors.initials: SC
authors.lastname: Tejedor
authors.forename: Gina
authors.initials: G
authors.lastname: Garrett
authors.forename: Jesse T
authors.initials: JT
authors.lastname: Jacob
authors.forename: Ellen
authors.initials: E
authors.lastname: Meyer
authors.forename: Mary Dent
authors.initials: MD
authors.lastname: Reyes
authors.forename: Chad
authors.initials: C
authors.lastname: Robichaux
authors.forename: James P
authors.initials: JP
authors.lastname: Steinberg
mesh_terms: D002405:Catheterization, Central Venous / Q000706:statistics & numerical data*; D057286:Electronic Health Records / Q000592:standards* / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007362:Intensive Care Units / Q000592:standards / Q000706:statistics & numerical data; D013997:Time Factors