Evaluated an electronic health record (EHR) "hard stop" intervention to reduce inappropriate urine culture (UC) orders in patients with indwelling urinary catheters (IUC).
Pre-post quasi-experimental retrospective study compared catheter-associated urinary tract infection (CAUTI) rates per 1,000 patient days, UC order rate per 1,000 catheter days, Standardized Utilization Ratio (SUR), and Standardized Infection Ratio (SIR) between pre-intervention period (Jan 2019-Dec 2020) and intervention period (Apr 2021-Dec 2024) across a five-hospital health system in Southeast Michigan. Implemented in March 2021, the EHR hard stop activated 24 hours after admission for patients with IUC >1 day and persisted until 4 days post-removal. Overrides required medical director approval following case review; real-time education was provided. Outcomes included pyelonephritis or bacteremia within 3 days and readmission for sepsis within 30 days when UC was deemed unnecessary.
CAUTI rates declined from 0.523 to 0.071 (86%; p<0.001). UC order rate decreased from 191.3 to 77.5 per 1,000 catheter days (59%; p<0.001). SUR declined from 0.809 to 0.769 (5%; 95% CI, 0.943-0.956; p<0.001). SIR decreased from 0.400 to 0.081 (81%; 95% CI, 0.124-0.32; p<0.001). Of 67 override requests, 65 (94%) were denied without adverse patient outcomes.
An EHR-based hard stop, integrated with real-time review and education, significantly reduced inappropriate UC orders and CAUTI rates without compromising patient safety.
American journal of infection control. 2026 Feb 10 [Epub ahead of print]
Geehan Suleyman, Anita Shallal, Abigail Ruby, Eman Chami, Tarlisha Holsey, Sarah Mckay, Kathy Callahan, Linoj Samuel, Ali A Dabaja, Robert J Tibbetts
System Infection Prevention and Control, Henry Ford Health, Detroit, MI. Electronic address: ., Division of Infectious Diseases, Henry Ford Health, Detroit, MI., Performance Excellence & Quality Department, Henry Ford Hospital, Detroit, MI., System Infection Prevention and Control, Henry Ford Health, Detroit, MI., Helios Information Technology, Henry Ford Health, Detroit, MI., Dept of Pathology and Laboratory Medicine, Henry Ford Health, Detroit, MI., Henry Ford Health, Department of Urology, Henry Ford Health, Detroit, MI.