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The goal of this randomized controlled trial is to compare the effects of a clinical decision support tool consisting of a 48-hour stop order for indwelling urinary catheters versus no clinical decision support in hospitalized patients with indwelling urinary catheters. The main questions it aims to answer are:
- Does the presence of an automated stop order integrated as part of a clinical decision support tool reduce dwell time of urinary catheters and the rate of catheter associated urinary tract infections?
Participants who have indwelling urinary catheters ordered will be randomized to either have these orders automatically expire after 48 hours unless an action is taken or have orders without expiration. Researchers will compare the urinary catheter dwell time and the rate of catheter associated urinary tract infections between the two groups.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Stop Orders | Experimental | For participants in this arm, a clinical decision support tool consisting of stop orders and an expiring alert that was displayed to care team clinicians. |
|
| Continuous Orders | No Intervention | For participants in this arm, no clinical decision support or alerts were displayed to care team clinicians and the urinary catheter order was continuous. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Clinical decision support | Other | A 48 hour expiration on orders placed for indwelling urinary catheters. |
|
| Measure | Description | Time Frame |
|---|---|---|
| Urinary catheter dwell time | The time between urinary catheter insertion and removal | Measured from time of catheter insertion until catheter removal or hospital discharge if the catheter was not removed, up to 250 days. |
| Measure | Description | Time Frame |
|---|---|---|
| Catheter Associate Urinary Tract Infection (CAUTI) rate | The number of CAUTI's per 1000 catheter days. CAUTIs were defined according to NHSN (National Healthcare Safety Network) criteria as a urinary tract infection where an indwelling urinary catheter (IUC) was in place for more than two consecutive days in an inpatient location on the date of event or the day before, with day of device placement being Day 1. All positive urine cultures are reviewed by members of Infection Prevention and Control to determine if they meet the defined criteria for CAUTI. Events verified as CAUTIs are then recorded in the hospital data registry. The hospital data registry was used to determine CAUTI events in this study. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Jason Adelman, MD, MS | Columbia University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| NewYork-Presbyterian Westchester | Bronxville | New York | 10708 | United States | ||
| NewYork-Presbyterian Brooklyn Methodist Hospital |
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| The development of a CAUTI was assessed from time of catheter insertion until either catheter removal or hospital discharge if the catheter was not removed, up to 250 days. |
| CAUTI population rate | The number of CAUTI's per 10000 hospital days CAUTIs were defined according to NHSN (National Healthcare Safety Network) criteria as a urinary tract infection where an indwelling urinary catheter (IUC) was in place for more than two consecutive days in an inpatient location on the date of event or the day before, with day of device placement being Day 1. All positive urine cultures are reviewed by members of Infection Prevention and Control to determine if they meet the defined criteria for CAUTI. Events verified as CAUTIs are then recorded in the hospital data registry. The hospital data registry was used to determine CAUTI events in this study. | The development of a CAUTI was assessed from time of catheter insertion until either catheter removal or hospital discharge if the catheter was not removed, up to 250 days. |
| CAUTI Free survival | The time a catheter "survived" before developing a CAUTI CAUTIs were defined according to NHSN (National Healthcare Safety Network) criteria as a urinary tract infection where an indwelling urinary catheter (IUC) was in place for more than two consecutive days in an inpatient location on the date of event or the day before, with day of device placement being Day 1. All positive urine cultures are reviewed by members of Infection Prevention and Control to determine if they meet the defined criteria for CAUTI. Events verified as CAUTIs are then recorded in the hospital data registry. The hospital data registry was used to determine CAUTI events in this study. | The development of a CAUTI was assessed from time of catheter insertion until either catheter removal or hospital discharge if the catheter was not removed, up to 250 days. |
| Brooklyn |
| New York |
| 11215 |
| United States |
| NewYork-Presbyterian Hudson Valley Hospital | Cortlandt Manor | New York | 10567 | United States |
| NewYork-Presbyterian Queens | Flushing | New York | 11355 | United States |
| NewYork-Presbyterian Columbia University Irving Medical Center | New York | New York | 10032 | United States |
| NewYork-Presbyterian Allen Hospital | New York | New York | 10034 | United States |
| NewYork-Presbyterian Lower Manhattan Hospital | New York | New York | 10038 | United States |
| NewYork-Presbyterian Weill Cornell Medical Center | New York | New York | 10065 | United States |
| ID | Term |
|---|---|
| D003428 | Cross Infection |
| ID | Term |
|---|---|
| D007239 | Infections |
| D007049 | Iatrogenic Disease |
| D020969 | Disease Attributes |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
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