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EHR Implementation Linked to Improved Quality Indicators in ICUs

MONTREAL – Implementation of an electronic health record system appeared to help reduce central line-associated bloodstream infections (CLABSI) and mortality rates in a large tertiary care hospital’s surgical intensive care unit.

The study, presented at the recent CHEST 2015 conference in Montreal, said the introduction of an EHR did not have an effect however, on length of stay, Clostridium difficile colitis incidence, or readmission rates.

The retrospective chart review by researchers from Icahn School of Medicine at Mount Sinai in New York focused on quality indicators for 3,742 patients admitted to the SICU two years before (Jan. 1, 2009, to Dec. 31, 2010) and two years after (Jan. 1, 2012, to Dec. 31, 2013) implementation of an Epic EHR system. Data from the 12-month period of transition to EHR was excluded.

Results indicate the rate of CLABSI per 1,000 catheter days was 85% lower and overall SICU mortality was 28% lower. EHR implementation also resulted in a significant increase in the average number of coded diagnoses from 17.8 to 20.8.

“After EHR implementation, there was no significant difference in multiple key quality of care indicators in the SICU. There were significant reductions in CLABSI rates and SICU mortality,” the authors write. “Ongoing quality improvement endeavors may explain the changes in CLABSI and mortality, but these trends invite further study of the possible impact of EHRs on quality of care in the ICU.”

Background data in the presentation abstract notes that “health information technology, and specifically the electronic health record (EHR), is increasingly viewed as a means to provide more coordinated, patient-centered care.”

“Considering the large investment into electronic health records and the high costs associated with ICU care, it’s important to develop EHRs that improve ICU quality of care,” according to the researchers.

Another recent study suggests how that might be accomplished. The research conducted at Children's National Health System in Washington, DC, demonstrates the effectiveness of an EHR querying tool created to assess compliance with a pediatric ICU Safety Bundle. Updated every five minutes, a real-time visual display showed data on presence of consent for treatment, restraint orders, presence of urinary catheters, deep venous thrombosis prophylaxis, Braden Q score, and medication reconciliation.

“A unit-wide dashboard can increase awareness for potential interventions, affecting patient safety in the PICU in a dynamic manner,” study authors write in the Joint Commission Journal on Quality and Patient Safety.

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