Study uses EHR program and targeted alert system to reduce UTIs

Electronic health record programs are continuously used by physicians to track and analyze trends related to the cause and treatment of various ailments. The most recent discovery by doctors using EHRs is that targeted automatic alerts can reduce urinary tract infections.

According to the U.S. Centers for Disease Control and Prevention, approximately 75 percent of UTIs occur after a urinary catheter has been inserted. Between 15 and 25 percent of hospitalized patients receive urinary catheters while at a hospital. Additionally, the CDC reported that prolonged use of a catheter is the leading cause of UTIs, and they are the most common infection related to health care.

The study's results
The study conducted by medical researchers and technology experts at the Perelman School of Medicine at the University of Pennsylvania will be published in the September issue of Infection Control and Hospital Epidemiology. The research team, led by Charles A. Baillie, M.D., internal medicine specialist at Penn Medicine, found that targeted automated alerts result in fewer catheter-associated UTIs. Also, when the alerts are faster and easier to identify, there was an increase in catheters removed from 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," said Baillie.

The method and statistics
The Penn Medicine study used 222,475 inpatient admissions between three hospitals in the UPenn Health System between March 2009 and May 2012. Physicians specified the reason for inserting a urinary catheter in the patients' EHRs, which helped the researchers decide on the recommended time period for removal of the catheter. An alert would be set and clinicians would assess the patients' need for the device.

The study consisted of two phases. In the first, urinary catheters were removed after a generic EHR stock alert was triggered. UTIs decreased from a rate of .84 per 1,000 patient days to .70 per 1,000 patient days.

To improve on those results, the second phase relied on an in-house-developed alert system that was created based on CDC guidelines. Researchers found that catheter removals increased by 15 percent. Rates of UTIs dropped to .50 per 1,000 patient days. The simpler alert only required two mouse clicks compared to seven mouse clicks to submit a remove catheter order.

"As more hospitals adopt electronic health records, studies such as ours can help point the way toward improved patient care," said Craig Umscheid, M.D., senior author, 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."

Similar studies were conducted before, but those used pen and paper notes. This Penn Medicine study was the first to use an EHR system as well as the largest patient sample size and longest time frame.