Intervening in the Emergency Department to Reduce Urinary Catheter Use

 描述(由申请人提供)：急诊科(ED)对导尿管放置的适当性的干预措施在多大程度上减少了不必要的导尿管使用尚不清楚。该项目的长期目标是确定和实施有效的策略，以减少急诊室不适当的导管使用，从而减少总体导管使用，并预防导管相关性尿路感染(CAUTI)。这项建议的目的是检查集中于减少急诊室不适当导管使用的合作努力的有效性，并确定影响这一跨多个地点的重要CAUTI预防策略的关键因素。由于ED在最初的导管放置中起着关键作用，因此建议进行这项研究的主要理由是，确保导管的正确使用和预防CAUTI需要确定和实施基于ED的干预措施。这项研究有两个具体目的：1)确定在两种不同的多地点干预措施(一种基于州和一种基于系统)减少急诊室不适当插入尿管后，尿管使用率和CAUTI率的变化并比较差异；2)确定和比较实施干预措施以减少不同组ED的尿管使用的障碍和促进者。在目标1中，将使用来自总共48家参与两个不同协作急诊干预的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 作为在基线、实施和可持续干预时间点收集的关于导管使用和适当性的过程测量数据。将结合特定部位的CAUTI率数据和特定于CAUTI的标准化感染率数据来评估结果。对于目标2，我们将使用定性方法，包括电话采访和现场访问。这种方法将使我们能够进一步检查复杂的组织因素， 在急诊室中充当减少不适当导管使用的促进者或障碍。拟议目标的预期结果是对ED干预后导管使用和CAUTI率变化的多点定量估计，以及对所观察到的量化变化背后的关键因素的洞察。这一结果将对感染预防和患者安全领域产生积极影响，为建立ED干预努力减少导管使用和CAUTI提供新的见解和方向。对这一研究领域的重大贡献预计将是了解协作性ED干预的有效性，检查在两个不同的组织框架(基于国家和基于系统)下实施协作性ED干预的影响，描述在通常繁忙的ED环境中促进或阻碍适当导管使用的许多方面，以及评估ED干预后CAUTI率的变化。拟议的创新、混合方法方法将产生有价值的信息，可用于为制定干预措施提供信息，这些干预措施可以根据全美ED的特定组织背景量身定做，并与有动机干预ED以减少CAUTI的组织分享。

 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.