Using a Multi-Center, Computer-Based Surveillance System: Overcoming Data Collection Challenges with the Use of Technology and Creative Teamwork

Abstract

ISSUE: Healthcare systems could benefit from a system-wide infection control surveillance database populated with data from component hospitals to assess the individual and collective effects of their infection programs. The challenge: obtain complete, accurate, and consistent data and, at the same time, not distract focus from prevention efforts. PROJECT: Tenet Healthcare, a system comprised of 113 hospitals, sought to develop an efficient data-collection and reporting system that provided outcome data in real time, allowed total hospital infection surveillance, and minimized manual data entry by using existing electronic hospital information systems. These data were automatically derived from the 1) admission, discharge, transfer database; 2) microbiology laboratory database; and 3) pharmacy database. Manual data entry was limited to case managers entering device use and device days and infection control practitioners (ICPs) identifying nosocomial infections. Accuracy of device data was assured by weekly assessment and cross-checking entered data with billing information and using CDC definitions to define nosocomial infections. Some hospitals assigned one individual to enter all device information to ensure complete data capture. ICPs met monthly to evaluate the system. RESULTS: Case Management, Infection Control, Nursing, and corporate managers collaborated to design an improved data collection system named eCARE (Electronic Clinical Analysis and Resource Efficiency). This program will be released by March 2004. New features include risk stratification, patient level “drill down” reports for all nosocomial infections, and comparative rate reports. LESSONS LEARNED: Focusing on three devices (central venous catheters, ventilators, and urinary catheters) made it easier to track device information. The inclusion of nursing management and directors of case management was crucial to successful denominator data collection, especially when measuring outside intensive care units. While hospital-wide data for internal benchmarking is helpful for identifying overall corporate rates, there is a need to stratify data by similar units to identify specific target areas for improvement. There is also a need to confidentially compare hospital-to-hospital data for external benchmarking.