Beginning in January 2011, hospitals will report central line‐associated bloodstream infections (CLABSIs) to the National Healthcare Safety Network (NHSN) per Center for Medicare and Medicaid Services (CMS) payment rules. The NHSN definition of CLABSI uses central line‐days as the denominator. Manual collection of line‐days is resource intensive, and NHSN allows for use of electronic data sources if line‐days are within 5% of the manual count. However, NHSN has no validation component at the facility level.
We sought to design and validate an accurate process to electronically “count” line‐days outside the ICU at 2 university hospitals with a total of 1000 beds and assess the impact of this intervention on CLABSI rates.
An electronic query was created to capture patient and line information along with a process for tracking, reporting, and correcting errors in documentation to improve the validity of the electronic data. The interventions included: an electronic error tracking tool, reeducation of 98% of the nursing staff, redesign of the documentation interface, audit and feedback of errors in real time, and a dedicated line champion. After the initial manual validation, an electronic documentation error tracking tool was developed to flag common errors leading to incorrect line‐day counts, used daily by a trained nurse covering 2 hospitals. Ongoing education focused on wards with a high error rate, and errors were corrected in real time. After validation of electronic data capture, CLABSI rates were calculated using both patient‐days and electronic line‐days for 2 selected wards over 8 months. Baseline, there were 3454 errors/month in 5576 line‐days, for an error rate of 0.6 /line‐days. Postintervention, there were 343 errors/month in 5061 line‐days, for an overall rate of 0.07/line‐days, now stable 19 months postintervention (Fig. 1). Baseline, a mean of 121 patients/day had ≥1 errors (81% involved a missing line type or insertion date), which decreased to 12 patients/day 13 months postintervention. There were 7 CLABSIs on ward A and 6 on ward B in the study period. Using the patient‐days denominator, ward A had a higher CLABSI rate than ward B (1.4 vs. 1.2/1000 patient‐days). However, using line‐days as the denominator, ward A had a lower rate than ward B (3.2 vs. 4.8/1000 line‐days).
FIGURE 1. The validity of the electronic central line day count depended on the quality of central line documentation. The documentation error rate improved with each system‐wide intervention.
Without intensive validation efforts, electronic line‐day counts had a high error rate. Combining an existing electronic data source with stepwise interventions yielded a highly accurate and reliable dataflow. These findings raise concern that nonvali‐dated data could adversely affect the quality of NHSN denominator line‐day data. Our pilot comparing CLABSI rates on 2 wards had discordant results depending on choice of denominator.
S. Chernetsky Tejedor ‐ Baxter Healthcare, research grant; J. Stein ‐ none; G. Garrett ‐ none; J. Jacob ‐ Baxter Healthcare, research grant; L. Phillips ‐ none; E. Meyer ‐ none; M. Dent Reyes ‐ Baxter Healthcare, research grant; C. Robichaux ‐ none; J. P. Steinberg ‐ Baxter Healthcare, research grant
To cite this abstract:Tejedor S, Stein J, Garrett G, Jacob J, Phillips L, Meyer E, Reyes M, Robichaux C, Steinberg J. Electronic Documentation of Central Line‐Days; Validation Is Essential. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 160. Journal of Hospital Medicine. 2011; 6 (suppl 2). https://www.shmabstracts.com/abstract/electronic-documentation-of-central-linedays-validation-is-essential/. Accessed April 1, 2020.