{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T10:48:25Z","timestamp":1773312505530,"version":"3.50.1"},"reference-count":43,"publisher":"Cambridge University Press (CUP)","issue":"8","license":[{"start":{"date-parts":[[2018,6,13]],"date-time":"2018-06-13T00:00:00Z","timestamp":1528848000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec id=\"S0899823X18001149_abs1\" sec-type=\"general\"><jats:title>Objective<\/jats:title><jats:p>To integrate electronic clinical decision support tools into clinical practice and to evaluate the impact on indwelling urinary catheter (IUC) use and catheter-associated urinary tract infections (CAUTIs).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X18001149_abs2\" sec-type=\"general\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>This 4-phase observational study included all inpatients at a multicampus, academic medical center between 2011 and 2015.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X18001149_abs3\" sec-type=\"general\"><jats:title>Interventions<\/jats:title><jats:p>Phase 1 comprised best practices training and standardization of electronic documentation. Phase 2 comprised real-time electronic tracking of IUC duration. In phase 3, a triggered alert reminded clinicians of IUC duration. In phase 4, a new IUC order (1) introduced automated order expiration and (2) required consideration of alternatives and selection of an appropriate indication.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X18001149_abs4\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Overall, 2,121 CAUTIs, 179,070 new catheters, 643,055 catheter days, and 2,186 reinsertions occurred in 3\u00b785 million hospitalized patient days during the study period. The CAUTI rate per 10,000 patient days decreased incrementally in each phase from 9\u00b706 in phase 1 to 1\u00b765 in phase 4 (relative risk [RR], 0\u00b7182; 95% confidence interval [CI], 0\u00b7153\u20130\u00b7216; <jats:italic>P<\/jats:italic>&lt;\u00b7001). New catheters per 1,000 patient days declined from 53\u00b74 in phase 1 to 39\u00b75 in phase 4 (RR, 0\u00b7740; 95% CI, 0\u00b7730; <jats:italic>P<\/jats:italic>&lt;\u00b7001), and catheter days per 1,000 patient days decreased from 194\u00b75 in phase 1 to 140\u00b77 in phase 4 (RR, 0\u00b7723; 95% CI, 0\u00b7719\u20130\u00b7728; <jats:italic>P<\/jats:italic>&lt;\u00b7001). The reinsertion rate declined from 3\u00b766% in phase 1 to 3\u00b725% in phase 4 (RR, 0\u00b7894; 95% CI, 0\u00b7834\u20130\u00b7959; <jats:italic>P<\/jats:italic>=\u00b70017).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X18001149_abs5\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>The phased introduction of decision support tools was associated with progressive declines in new catheters, total catheter days, and CAUTIs. Clinical decision support tools offer a viable and scalable intervention to target hospital-wide IUC use and hold promise for other quality improvement initiatives.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2018.114","type":"journal-article","created":{"date-parts":[[2018,6,13]],"date-time":"2018-06-13T02:02:21Z","timestamp":1528855341000},"page":"902-908","source":"Crossref","is-referenced-by-count":7,"title":["Reducing indwelling urinary catheter use through staged introduction of electronic clinical decision support in a multicenter hospital system"],"prefix":"10.1017","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4792-3190","authenticated-orcid":false,"given":"Brett E.","family":"Youngerman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9004-7149","authenticated-orcid":false,"given":"Hojjat","family":"Salmasian","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eileen J.","family":"Carter","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael L.","family":"Loftus","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rimma","family":"Perotte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara G.","family":"Ross","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E. Yoko","family":"Furuya","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert A.","family":"Green","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David K.","family":"Vawdrey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2018,6,13]]},"reference":[{"key":"S0899823X18001149_ref29","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(02)01568-1"},{"key":"S0899823X18001149_ref21","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-010-1829-1"},{"key":"S0899823X18001149_ref43","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2013.10.003"},{"key":"S0899823X18001149_ref10","doi-asserted-by":"publisher","DOI":"10.4324\/9781498757461"},{"key":"S0899823X18001149_ref40","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2009.12.017"},{"key":"S0899823X18001149_ref37","doi-asserted-by":"publisher","DOI":"10.1126\/science.1091721"},{"key":"S0899823X18001149_ref27","doi-asserted-by":"publisher","DOI":"10.1016\/j.jen.2009.04.017"},{"key":"S0899823X18001149_ref23","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1995.00430130115012"},{"key":"S0899823X18001149_ref20","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-013-2536-8"},{"key":"S0899823X18001149_ref2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir195"},{"key":"S0899823X18001149_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2013.08.015"},{"key":"S0899823X18001149_ref14","unstructured":"National Healthcare Safety Network (NHSN). Surveillance for urinary tract infections. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/https:\/\/www.cdc.gov\/nhsn\/acute-care-hospital\/cauti\/. Published 2017. Accessed April 19, 2017."},{"key":"S0899823X18001149_ref34","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.163.21.2625"},{"key":"S0899823X18001149_ref39","doi-asserted-by":"publisher","DOI":"10.1177\/1062860605276074"},{"key":"S0899823X18001149_ref24","first-page":"99","article-title":"Overutilization of indwelling urinary catheters and the development of nosocomial urinary tract infections","volume":"6","author":"Gardam","year":"1998","journal-title":"Clin Perform Qual Health Care"},{"key":"S0899823X18001149_ref25","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2011.627"},{"key":"S0899823X18001149_ref11","doi-asserted-by":"publisher","DOI":"10.1086\/651091"},{"key":"S0899823X18001149_ref32","first-page":"20","article-title":"Reducing urinary tract infection: a nurse-initiated program","volume":"62","author":"Murphy","year":"2007","journal-title":"Penn Nurse"},{"key":"S0899823X18001149_ref15","unstructured":"National Healthcare Safety Network (NHSN). Paving the path forward: 2015 rebaseline. Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/nhsn\/2015rebaseline\/. Published April 19, 2017. Accessed April 19, 2017."},{"key":"S0899823X18001149_ref35","doi-asserted-by":"publisher","DOI":"10.1136\/amiajnl-2011-000743"},{"key":"S0899823X18001149_ref38","doi-asserted-by":"publisher","DOI":"10.1086\/503837"},{"key":"S0899823X18001149_ref3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197408012910501"},{"key":"S0899823X18001149_ref36","doi-asserted-by":"publisher","DOI":"10.1136\/jamia.2010.008441"},{"key":"S0899823X18001149_ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2014.11.014"},{"key":"S0899823X18001149_ref30","first-page":"172","article-title":"Utilizing national nosocomial infection surveillance system data to improve urinary tract infection rates in three intensive-care units","volume":"6","author":"Dumigan","year":"1998","journal-title":"Clin Perform Qual Health Care"},{"key":"S0899823X18001149_ref16","doi-asserted-by":"publisher","DOI":"10.1086\/660765"},{"key":"S0899823X18001149_ref18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1504906"},{"key":"S0899823X18001149_ref6","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2012-001774"},{"key":"S0899823X18001149_ref42","doi-asserted-by":"publisher","DOI":"10.3171\/2011.11.JNS11974"},{"key":"S0899823X18001149_ref28","doi-asserted-by":"publisher","DOI":"10.1097\/NCQ.0b013e318248b0b1"},{"key":"S0899823X18001149_ref19","doi-asserted-by":"publisher","DOI":"10.1086\/502291"},{"key":"S0899823X18001149_ref8","doi-asserted-by":"publisher","DOI":"10.1086\/677630"},{"key":"S0899823X18001149_ref4","doi-asserted-by":"publisher","DOI":"10.3201\/eid0702.010240"},{"key":"S0899823X18001149_ref33","first-page":"272","article-title":"Reducing Foley catheter device days in an intensive care unit: using the evidence to change practice","volume":"17","author":"Reilly","year":"2006","journal-title":"AACN Adv Crit Care"},{"key":"S0899823X18001149_ref5","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9343(02)01054-9"},{"key":"S0899823X18001149_ref1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-150-12-200906160-00013"},{"key":"S0899823X18001149_ref31","doi-asserted-by":"publisher","DOI":"10.1086\/502329"},{"key":"S0899823X18001149_ref41","doi-asserted-by":"publisher","DOI":"10.1097\/01.NAJ.0000387691.47746.b5"},{"key":"S0899823X18001149_ref26","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2006.12.004"},{"key":"S0899823X18001149_ref12","first-page":"1132","article-title":"EpiPortal: an electronic decision support system for infection control","author":"Wajngurt","year":"2006","journal-title":"AMIA Ann Sympos Proc"},{"key":"S0899823X18001149_ref9","doi-asserted-by":"publisher","DOI":"10.1086\/677630"},{"key":"S0899823X18001149_ref7","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir188"},{"key":"S0899823X18001149_ref17","unstructured":"R Core Team. R: a language and environment for statistical computing. R Project website. http:\/\/www.R-project.org\/. Published 2017. Accessed April 16, 2017."}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X18001149","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2019,4,13]],"date-time":"2019-04-13T18:48:58Z","timestamp":1555181338000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X18001149\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,13]]},"references-count":43,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2018,8]]}},"alternative-id":["S0899823X18001149"],"URL":"https:\/\/doi.org\/10.1017\/ice.2018.114","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,13]]}}}