Jacobi Medical Center earned a 2014 Gage Award honorable mention for quality.
The Centers for Disease Control and Prevention says urinary tract infections (UTIs) are the most common health care-associated infection reported to the National Healthcare Safety Network (NHSN). Among UTIs acquired in the hospital, approximately 75 percent are associated with a urinary catheter. In 2012, Jacobi Medical Center – a member of the New York City Health and Hospitals Corporation – set out to decrease the number of patients harmed by catheter-associated urinary tract infections (CAUTIs) and, in doing so, improve the interdisciplinary communication necessary to eliminate risk and harm to patients. Through evidence-based practices, systemwide education, and real-time review, the hospital has met both of these goals.
Proven Tools Provide Basis for Change
First, Jacobi convened a multidisciplinary team to examine the hospital’s CAUTI data. The team identified gaps in practice and set out to implement evidence-based solutions, with the goal of reaching zero CAUTIs across the organization.
Using available literature, the team established clinical competencies for the three steps associated with catheter care:
1. indication/insertion (with patient involvement)
2. maintenance (with patient involvement)
3. postremoval care (with patient involvement)
Having learned that one of Jacobi’s key gaps in CAUTI prevention was systemwide education for providers, patients, and families, the hospital embarked on a comprehensive educational campaign, including the following elements:
- grand rounds on CAUTI reduction
- on admission, patient and family education about catheter care and early removal
- videos in patient rooms about catheter care and early removal
- a display board in patient rooms indicating the number of days a catheter has been inserted
Jacobi used the dyad model of leadership, including both physicians and administrators in driving and sustaining improved outcomes and operational change. As part of this approach, unit-based nurse and physician champions helped promote relevant indications and early catheter removal. During interdisciplinary rounds, staff discussed catheter appropriateness in an attempt to reduce catheter days. Interdisciplinary teams held biweekly meetings and used the plan – do – study – act approach to review data and address immediate issues.
The hospital also employed TeamSTEPPS tools, such as huddles, briefs, and debriefs, and developed a bladder scanner protocol to avoid unnecessary reinsertion.
Applying continuous quality improvement, the hospital reviewed every CAUTI in real time using root-cause analysis. Staff identified gaps and areas for improvement. They also identified best practices and shared them with all staff. Posters in each unit displayed the number of days since the last CAUTI.
As a result of these practices, the hospital reduced CAUTIs by more than 65 percent and indwelling catheter days by more than 20 percent in the first three quarters of 2013. What’s more, 6 out of 15 units (40 percent) reached the goal of zero CAUTIs in 2013.
In addition to these clinical achievements, the hospital has effectively changed its culture around this issue. There is an increased awareness of indwelling urinary catheters and CAUTIs in clinical areas, which instills a sense of ownership at the unit level. The hospital also successfully demonstrated the impact decreasing catheter days has on the occurrence of CAUTI, and how this work decreases harm and patient morbidity.
For more information about Jacobi’s award-winning work to eliminate CAUTIs, please contact:
Amit Singh Tibb, MD
Director, Medical Intensive Care Unit
Jacobi Medical Center