An effective computerized reminder for contact isolation of patients colonized or infected with resistant organisms

PURPOSE To improve contact isolation rates among patients admitted to the hospital with a known history of infection with Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococci (VRE). METHODS A before and after interventional study implementing computerized reminders for contact isolation between February 25, 2005 and February 28, 2006. We measured rates of appropriate contact isolation, and time to isolation for the 4 month pre-intervention period, and the 12 month intervention period. We conducted a survey of ordering physicians at the midpoint of the intervention period. RESULTS Implementing a computerized reminder increased the rate of patients appropriately isolated from 33% to fully 89% (P<0.0001). The median time to writing contact isolation orders decreased from 16.6 to 0.0 h (P<0.0001). Physicians accepted the order 80% of the time on the first or second presentation. Ninety-five percent of physicians felt the reminder had no impact on workflow, or saved them time. CONCLUSION A human reviewed computerized reminder can achieve high rates of compliance with infection control recommendations for contact isolation, and dramatically reduce the time to orders being written upon admission.

[1]  J R Scherrer,et al.  Automatic Alerts for Methicillin-Resistant Staphylococcus aureus Surveillance and Control: Role of a Hospital Information System , 1996, Infection Control &#x0026; Hospital Epidemiology.

[2]  C. McDonald,et al.  Reminders to physicians from an introspective computer medical record. A two-year randomized trial. , 1984, Annals of internal medicine.

[3]  C J McDonald,et al.  A tool for provider interaction during patient care: G-CARE. , 1995, Proceedings. Symposium on Computer Applications in Medical Care.

[4]  W M Tierney,et al.  Effectiveness of Computer-Generated Reminders for Increasing Discussions about Advance Directives and Completion of Advance Directive Forms , 1998, Annals of Internal Medicine.

[5]  T. Karchmer,et al.  Cost-effectiveness of active surveillance cultures and contact/droplet precautions for control of methicillin-resistant Staphylococcus aureus. , 2002, The Journal of hospital infection.

[6]  David W Bates,et al.  Safety of patients isolated for infection control. , 2003, JAMA.

[7]  Marc Berg,et al.  Viewpoint Paper: Some Unintended Consequences of Information Technology in Health Care: The Nature of Patient Care Information System-related Errors , 2003, J. Am. Medical Informatics Assoc..

[8]  R. P. Wenzel,et al.  The Direct Costs of Universal Precautions in a Teaching Hospital , 1991 .

[9]  Nnis System.  National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2003, issued August 2003. , 2003, American journal of infection control.

[10]  National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. , 2004, American journal of infection control.

[11]  Marilyn D Paterno,et al.  Electronic alerts to prevent venous thromboembolism among hospitalized patients. , 2005, The New England journal of medicine.

[12]  A. Troelstra,et al.  Costs Associated with a Strict Policy to Eradicate Methicillin-Resistant Staphylococcus aureus in a Dutch University Medical Center: A 10-Year Survey , 2002, European Journal of Clinical Microbiology and Infectious Diseases.

[13]  C. McDonald.  Protocol-based computer reminders, the quality of care and the non-perfectability of man. , 1976, The New England journal of medicine.

[14]  Joseph Finkelstein,et al.  Identifying groups at high risk for carriage of antibiotic-resistant bacteria. , 2006, Archives of internal medicine.

[15]  S. Cosgrove,et al.  The Impact of Methicillin Resistance in Staphylococcus aureus Bacteremia on Patient Outcomes: Mortality, Length of Stay, and Hospital Charges , 2005, Infection Control &#x0026; Hospital Epidemiology.

[16]  William L. Galanter,et al.  Application of Information Technology: A Trial of Automated Decision Support Alerts for Contraindicated Medications Using Computerized Physician Order Entry , 2005, J. Am. Medical Informatics Assoc..

[17]  R. Lynfield,et al.  Methicillin-resistant Staphylococcus aureus disease in three communities. , 2005, The New England journal of medicine.

[18]  J. P. Kichak,et al.  Computerized physician order entry: helpful or harmful? , 2003, Journal of the American Medical Informatics Association : JAMIA.

[19]  B S Cooper,et al.  Isolation measures in the hospital management of methicillin resistant Staphylococcus aureus (MRSA): systematic review of the literature , 2004, BMJ : British Medical Journal.

[20]  John M Boyce,et al.  Do Infection Control Measures Work for Methicillin-Resistant Staphylococcus aureus? , 2004, Infection Control &#x0026; Hospital Epidemiology.

[21]  Carlene A. Muto,et al.  SHEA Guideline for Preventing Nosocomial Transmission of Multidrug-Resistant Strains of Staphylococcus aureus and Enterococcus , 2003, Infection Control &#x0026; Hospital Epidemiology.

[22]  Marc Berg,et al.  System-related Errors Nature of Patient Care Information Information Technology in Health Care: The Some Unintended Consequences of , 2010 .

[23]  Paul R Dexter,et al.  Inpatient computer-based standing orders vs physician reminders to increase influenza and pneumococcal vaccination rates: a randomized trial. , 2004, JAMA.

[24]  G J Kuperman,et al.  A randomized trial of a computer-based intervention to reduce utilization of redundant laboratory tests. , 1999, The American journal of medicine.

[25]  C. McDonald,et al.  A computerized reminder system to increase the use of preventive care for hospitalized patients. , 2001, The New England journal of medicine.

[26]  Lonnie Blevins,et al.  The Indiana network for patient care: a working local health information infrastructure. An example of a working infrastructure collaboration that links data from five health systems and hundreds of millions of entries. , 2005, Health affairs.