534. Accuracy of electronic data in estimating the number of inpatients with a urinary catheter
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: The Center for Disease Control considers hospital rates of catheter-associated urinary tract infections (CA-UTI) an important clinical measurement. The electronic medical record (EMR) purportedly represents a robust database from which one may efficiently calculate rates of CA-UTI. We sought to determine the utility of specific electronic data that might identify patients at risk for CA-UTI, namely those with a urinary catheter (UC).
Methods: We identified all patients admitted to Rush University Medical Center in Chicago, IL who had nursing flowsheet data for UC care from July 1, 2008 through March 31, 2009. We categorized patients by the method of catheter identification: charge for catheter; electronic order for catheter placement or removal; or, electronic nursing flowsheet entry. We then determined the proportion of patients identified with UC using each method compared to a gold standard. We considered nursing flowsheet data as the gold standard after a pilot study revealed 100 percent agreement between this data and contemporaneous bedside observation of a UC.
Results: We reviewed 2113 unique inpatient encounters as identified by flowsheet data. Neither UC charges nor UC orders provided good estimates of the presence of a UC: 130 charges for UC (6.15% of all flowsheet encounters); 863 UC orders (40.84% of flowsheet encounters.
Conclusion: Urinary catheter orders and charge data fail to identify the majority of inpatients with a urinary catheter. Underestimation of at-risk patients will lead to overestimation of CA-UTI rates. Nursing flowsheet data provides the most accurate estimate of patients at risk for CA-UTI.
David Ansell, MD, MPH1, Raj Behal, MD, MPH1, Brian Harting, MD2, Tricia Johnson, PhD1, Robert McNutt, MD1, Richard Odwazny, MS1 and  B. Harting,
Cardinal Health Role(s): Grant Investigator, Received: Grant Recipient.
T. Johnson, None..
R. Odwazny, None..
R. Behal, None..
D. Ansell, None..
R. McNutt, None., (1)Rush University Medical Center, Chicago, IL, (2)Rush University Medical Center, Hinsdale, IL