A Trial of electronic surveillance feedback for quality improvement at Nurses Improving Care for Healthsystem Elders (NICHE) hospitals.

BACKGROUND

Catheter-associated urinary tract infection (CAUTI) risk is directly related to duration of indwelling urinary catheters (IUCs), rising beyond 2 days of catheterization.

METHODS

We conducted a cluster randomized study in nonintensive care units of Nurses Improving Care for Healthsystem Elders (NICHE) hospitals. Electronic surveillance data were used in an audit and feedback intervention for frontline nurses to reduce IUC duration. Multivariable methods were used to identify the difference in average IUC duration and proportion of patients with IUC duration <3 days between patients in an early intervention group and a delayed intervention group, adjusting for patient, unit, and hospital characteristics.

RESULTS

A total of 24 units at 19 NICHE hospitals reported 13,499 adult patients with IUCs over 18 months. Early and delayed intervention groups had important baseline differences in IUC utilization. Use of evidence-based CAUTI prevention measures increased during study participation. In multivariable analysis, the average IUC duration and proportion of patients with IUC duration <3 days were not improved in the early intervention group compared with the delayed intervention group.

CONCLUSION

The impact of the audit and feedback intervention was not significant despite the uptake of evidence-based CAUTI prevention practices.