Intervening in the Emergency Department to Reduce Urinary Catheter Use

对急诊科进行干预以减少导尿管的使用

基本信息

批准号：
9115591
负责人：
Michael Todd Greene
金额：
$ 23.25万
依托单位：
UNIVERSITY OF MICHIGAN AT ANN ARBOR
依托单位国家：
美国
项目类别：
财政年份：
2015
资助国家：
美国
起止时间：
2015-08-01 至 2018-07-31
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): The extent to which interventions focused on appropriateness of urinary catheter placement reduce unnecessary urinary catheter use in the emergency department (ED) is not well understood. The long-term goal of this project is to identify and implement effective strategies to reduce inappropriate catheter use in the ED, thereby reducing overall catheter use and preventing catheter-associated urinary tract infection (CAUTI). The objectives of this proposal are to examine the effectiveness of collaborative efforts focused on reducing inappropriate catheter use in the ED and to identify key factors influencing this important CAUTI prevention strategy across multiple sites. Since the ED plays a key role in initial catheter placement, the main rationale for the proposed research is that ensuring the appropriate use of catheters and preventing CAUTI requires identifying and implementing ED-based interventions. This study has two specific aims: 1) To determine changes and compare differences in urinary catheter use and CAUTI rates following 2 distinct multi-site interventions (one state-based and one system-based) to reduce inappropriate urinary catheter insertion in the ED; and 2) To identify and compare the barriers to and facilitators of implementing interventions to reduce urinary catheter use across a diverse group of EDs. Secondary analyses using quantitative data from a total of 48 hospitals participating in 2 distinct collaborative ED interventions will be conducted in Aim 1. These data will include hospital characteristics, as well as process measure data on catheter use and appropriateness collected at baseline, implementation and sustainability time points of the interventions. A combination of site-specific CAUTI rate data and CAUTI- specific standardized infection ratio data will be used to assess outcomes. For Aim 2 we will use qualitative methods, consisting of both phone interviews and site visits. This approach will allow us to further examine the complex organizational factors that serve as either facilitators or barriers to reducing inappropriate catheter use in the ED. The expected outcomes of the proposed aims are multi-site quantitative estimates of changes in catheter use and CAUTI rates following ED interventions, as well as insights into key factors underlying the quantitative changes observed. The results will positively impact the fields of infection prevention and patient safety by providing novel insights and direction for establishing ED intervention efforts to reduce catheter use and CAUTI. The significant contribution to this area of research is expected to be an understanding of the effectiveness of collaborative ED interventions, an examination of the influence of implementing collaborative ED interventions under 2 distinct organizational frameworks (state- vs. system based), a delineation of the numerous aspects that facilitate or impede appropriate catheter use in typically busy ED environments, and an assessment of CAUTI rate changes following ED interventions. The proposed innovative, mixed-methods approach will yield valuable information that can be used to inform the development of interventions that can be tailored to the particular organizational context of EDs across the United States and shared with organizations motivated to intervene in the ED to reduce CAUTI.

描述（由适用提供）：尚不清楚急诊室（ED）中不必要的尿导管使用的干预措施的干预措施的程度尚未得到很好的了解。该项目的长期目标是确定和实施有效的策略，以减少ED中不适当的导管使用，从而减少总导管的使用并防止导管相关的尿路感染（CAUTI）。该提案的目标是研究旨在减少ED中不适当的导管使用的协作努力的有效性，并确定影响多个站点的这一重要预防CAUTI预防策略的关键因素。由于ED在初始导管放置中起着关键作用，因此提出的研究的主要理由是确保适当使用导管并防止CAUTI识别和实施基于ED的干预措施。这项研究具有两个具体的目的：1）确定2种不同的多站点干预措施（一种基于州和一个基于系统的一个基于一个系统和一个基于系统）之后的变化和比较尿导管使用和CAUTI速率的差异，以减少ED中不适当的尿管插入； 2）识别和比较实施干预措施的障碍和促进者，以减少急潜水员ED的泌尿导管使用。使用来自AIM 1中的2个不同协作性干预措施的48家医院的定量数据进行二次分析。这些数据还将包括医院特征作为有关在基线时收集的导管使用和适当性的过程测量数据，干预措施的实施和可持续性时间点。位点特异性的CAUTI速率数据和特定标准化感染比数据的组合将用于评估结果。对于AIM 2，我们将使用定性方法，包括电话访谈和现场访问。这种方法将使我们能够进一步研究复杂的组织因素作为减少ED中不适当导管使用的促进者或障碍。所提出的目标的预期结果是在ED干预后的导管使用变化和CAUTI速率变化的多站点定量估计，以及对观察到的定量变化的关键因素的见解。结果将通过提供新的见解和指导来建立ED干预措施，以减少导管的使用和CAUTI，从而对预防感染和患者安全的领域产生积极影响。预计对这一研究领域的重大贡献将是对合作性干预措施的有效性的理解，对在2个不同的组织框架下实施协作的干预措施的影响（基于国家与系统）的影响，这是对众多方面的决定，这些方面促进或阻碍了适当的导管在通常繁忙的ED环境中使用适当的导管，并评估了Cauti Interventions的评估。拟议的创新，混合方法方法将产生有价值的信息，可用于告知干预措施的开发，这些干预措施可以针对美国EDS的特定组织环境量身定制，并与有动力进行干预以减少CAUTI的组织共享。