title: Usability and impact of a computerized clinical decision support intervention designed to reduce urinary catheter utilization and catheter-associated urinary tract infections.
abstract: OBJECTIVE
  To evaluate the usability and effectiveness of a computerized clinical decision support (CDS) intervention aimed at reducing the duration of urinary tract catheterizations.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Academic healthcare system.
  
  
  METHODS
  All adult patients admitted from March 2009 through May 2012.
  
  
  METHODS
  A CDS intervention was integrated into a commercial electronic health record. Providers were prompted at order entry to specify the indication for urinary catheter insertion. On the basis of the indication chosen, providers were alerted to reassess the need for the urinary catheter if it was not removed within the recommended time. Three time periods were examined: baseline, after implementation of the first intervention (stock reminder), and after a second iteration (homegrown reminder). The primary endpoint was the usability of the intervention as measured by the proportion of reminders through which providers submitted a remove urinary catheter order. Secondary endpoints were the urinary catheter utilization ratio and the rate of hospital-acquired catheter-associated urinary tract infections (CAUTIs).
  
  
  RESULTS
  The first intervention displayed limited usability, with 2% of reminders resulting in a remove order. Usability improved to 15% with the revised reminder. The catheter utilization ratio declined over the 3 time periods (0.22, 0.20, and 0.19, respectively; P < .001), as did CAUTIs per 1,000 patient-days (0.84, 0.70, and 0.51, respectively; P < .001).
  
  
  CONCLUSIONS
  A urinary catheter removal reminder system was successfully integrated within a healthcare system's electronic health record. The usability of the reminder was highly dependent on its user interface, with a homegrown version of the reminder resulting in higher impact than a stock reminder.
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Baillie
authors.forename: Mika
authors.initials: M
authors.lastname: Epps
authors.forename: Asaf
authors.initials: A
authors.lastname: Hanish
authors.forename: Neil O
authors.initials: NO
authors.lastname: Fishman
authors.forename: Benjamin
authors.initials: B
authors.lastname: French
authors.forename: Craig A
authors.initials: CA
authors.lastname: Umscheid
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055499:Catheter-Related Infections / Q000517:prevention & control*; D002408:Catheters, Indwelling; D015331:Cohort Studies; D003428:Cross Infection / Q000517:prevention & control*; D020000:Decision Support Systems, Clinical / Q000458:organization & administration*; D020878:Device Removal / Q000706:statistics & numerical data*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012044:Regression Analysis; D017010:Reminder Systems; D012189:Retrospective Studies; D014546:Urinary Catheterization / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D062885:Urinary Catheters; D014552:Urinary Tract Infections / Q000517:prevention & control*; D055815:Young Adult
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