About: Stamford Hospital is a 305-bed community teaching hospital, an affiliate of the New York-Presbyterian Healthcare System, and a major teaching affiliate of the Columbia University College of Physicians & Surgeons.
The Need For Improvement: According to the CDC, hospital-acquired CAUTI increases length of stay, mortality, and hospitalization costs, with the average per patient direct costs and attributable mortality at $750 per episode. Despite broad-based education, hand-hygiene efforts, and environmental cleaning initiatives, Stamford Hospital’s urinary catheter utilization rates and CAUTI had not fallen over a five-year period.
Execution: Leveraging the MEDITECH EHR’s documentation, CPOE, clinical decision support, and reporting tools, Stamford enhanced communication between nurses and physicians on the need for catheters and made it easier for their clinicians to follow best practices. The organization developed a set of interventions to minimize the risk of catheter-associated urinary tract infections, including the following steps initiated in the EHR:
- The Infection Prevention team developed guidelines for physicians to document catheter insertion criteria when ordering catheters. They also developed electronic order sets with Foley time limits.
- They linked the order for “Foley Maintenance Protocol”, which includes the nursing checklist for catheter removal to the physician’s catheter insertion order.
- Nurses regularly review the reason for a catheter and are required on every shift to document the patient’s voiding method. A nurse-driven protocol allows nurses to remove the catheter when no longer needed.
Results: The results of Stamford Hospital’s CAUTI Reduction Program have been impressive. They successfully sustained reductions in hospital-wide catheter-associated urinary tract infections and Foley catheter use, as demonstrated by the data below:
- Reduced hospital-wide urinary catheter use by 50 percent and urinary tract infections by over 70 percent
- Saved an estimated $100,000 and six patient lives over a three-year period
- Lowered the incidence of hospital-wide CAUTI numbers from 14 per quarter to 2 per quarter and hospital-wide CAUTI rates have trended down from 4.3 infections per 1,000 catheter-days to 1.4 infections per 1,000 catheter-days.
An important aspect of any quality initiative is sustainability and Stamford’s results over several years demonstrate the effectiveness of the CAUTI program. To learn more, be sure to download our full case study.
