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

Abstract

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 Vancomycinresistant Enterococci (VRE).Methods-A before and after interventional study implementing computerized reminders for contact isolation between February 25th of 2005 and February 28th of 2006. We measured rates of appropriate contact isolation, and time to isolation for the four 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 hours to 0.0 hours (P < 0.0001). Physicians accepted the order 80% of the time on the first or second presentation. 95% 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.

A Web-Based Multidrug-Resistant Organisms Surveillance and Outbreak Detection System with Rule-Based Classification and Clustering

“…In accordance with the results of previous studies, including those of Kho et al [14], using a computer-assisted system provided a higher proportion of contact isolations than without computer assistance. A computerized decision support system could further improve risk measurement in other aspects of health care [34-35].…”

“…A computerized decision support system could further improve risk measurement in other aspects of health care [34-35]. The present computer-assisted MDRO surveillance system can provide precise and consistent support to the health care provider [14,16,36-37] and demonstrates usefulness for infection control. Huang et al implemented an automated statistical software that provided valuable real-time guidance by both identifying otherwise unrecognized outbreaks and preventing the unnecessary implementation of resource-intensive infection control measures that interfere with regular patient care [38].…”

“…Previous studies have devised and implemented computer-assisted infection control surveillance or outbreak detection systems, and these have proved beneficial in MDRO surveillance [14-17]. However, prior attempts to establish a Web-based MDRO surveillance system that allows automated real-time integration, analysis, and interpretation have been few.…”

Assessment and Evaluation Tools for Health-Care Ergonomics: Musculoskeletal Disorders and Patient Handling

“…Computerized alerts may decrease error rates and improve therapy . Computerized clinical reminders can increase compliance with guidelines (Kho et al, 2008) and preventive screening (Shea et al, 1996), improve clinical practice (Kawamoto et al, 2005), and may even save physicians time (Kho et al, 2008). At the same time, "…there are few CDS implementations to date in routine clinical use that have substantially delivered on the promise to improve healthcare processes and outcomes, though there have been an array of successes at specific sites …Yet even these successes have generally not been widely replicated" (Sittig et al, 2008).…”

“…Evidence is mixed for the effectiveness of CDS (Shea et al, 1996;Bates et al, 2001;Kho et al, 2008), CPOE Kaushal and Bates, 2001;Mekhjian et al, 2002;Kaushal et al, 2003;King et al, 2003;Kuperman and Gibson, 2003;Potts et al, 2004;Kaushal et al, 2006;Shamliyan et al, 2008), bar coded medication administration (BCMA) systems (Patterson et al, 2002;Koppel et al, 2008), and EHRs (Chaudhry et al, 2006;Linder et al, 2007;Zhou et al, 2009;Himmelstein et al, 2010;Jones et al, 2010;Poon et al, 2010b).…”