Medical Record Documentation Research Articles

Review of the Implementation of Minimum Service Standards (SPM) Provision of Outpatient Medical Record Documents for Dr. Panti Wilasa Hospital Cipto Semarang

Background: Minimum Service Standards have set up at Panti Wilasa Hospital Dr. Cipto Semarang that the standard time of outpatient services is 10 minutes which is calculated from the registration process. From the data obtained by the researcher from the assignment in carrying out the Minimal Standard of Service in serving the outpatients has been fully implemented. However, there are still healthcare service workers who do not understand the Minimum Service Standards when interviewing healthcare service officers in the Outpatient Registration Place section.Methods: This type of research is descriptive research that gives an overview of the data as a result of research. The method used is interviewing the outpatient registration officer and filing. Sampling technique in this study using random sampling data with a sample size of 30 person.Results: There is no specific Standard Operating Procedure (SOP) regarding the provision of outpatient medical records which were interviewed to the head of the medical records, which is already quite a good service at the outpatient registration place Dr. Panti Wilasa Hospital Cipto Semarang and Standard Operating Procedure (SOP) for Minimum Service Standards (SPM) in outpatient registration conducted interviews with the head of the medical record at Panti Wilasa Hospital Dr. Cipto Semarang. Results of the study showed that the average rapidity in medical record document provision was 31 minutes 20 seconds. At the Wilasa Panti Hospital Dr. Cipto Semarang, that the time for providing more medical records is more than ten minutes.Conclusions: The standard time for providing medical records is included in the Standard Operating Procedure (SOP) for the collection and compilation of medical records on a storage rack, so that medical records officers can work on the basis and rules that have been determined and the standard time for providing medical records is included in the quality objectives, The results are announced and written in a place easily seen by officers, Monitoring active medical record storage racks regularly by medical records officers and this can reduce the wrong medical record documents.

Documentation of Sleep Hygiene With Melatonin Use in Management of Sleep Disturbance in Children With Neurodevelopmental Disorders: A Quality Improvement Project.

The purpose of this quality improvement project was to improve health-care provider consistency in addressing and documenting the use of sleep hygiene in children with neurodevelopmental disorders in alignment with evidence-based strategies. The project took place over 12 weeks and used a parent-completed screening tool and SmartPhrase technology incorporated into the patient note and discharge summary. A preimplementation and postimplementation query of the electronic medical record was used to determine change effectiveness. The postimplementation query found a 42% increase in documentation of sleep hygiene. In addition, a 55% increase in documentation of sleep hygiene with the initiation of melatonin was noted. The increase in documentation supports success of this initial practice change and demonstrates adherence to evidence-based sleep hygiene strategies. The project provided evidence of a significant improvement in electronic medical record documentation, highlighting an increased awareness of sleep issues in children with neurodevelopmental disorders.

A Retrospective Study of Risk Factors for Redocumentation of Penicillin Allergy

Electronic Medical Record (EMR) documentation of allergies is critical for patient safety and efficacious for appropriate treatment. Inaccuracies in documentation can cause serious problems and lead to increase in mortality and morbidity. Studies have addressed the detrimental effects of redocumentation of penicillin (PCN) though few have expanded on risk factors.

Managing Nonmedical Opioid Use Among Patients With Cancer Pain During the COVID-19 Pandemic Using the CHAT Model and Telehealth

Managing Nonmedical Opioid Use Among Patients With Cancer Pain During the COVID-19 Pandemic Using the CHAT Model and Telehealth

SHA-256 based Encapsulated Electronic Medical Record Document Storage System

SHA-256 based Encapsulated Electronic Medical Record Document Storage System

Medical record documentation quality in the hospital accreditation.

BACKGROUND:Medical records constitute a legal and professional document regarding the activities of medical staff in hospitals. This study was conducted with the aim of identifying the factors that affect the quality of medical records by implementing the accreditation models in hospitals.MATERIALS AND METHODS:This was a qualitative study. The data were collected via 28 semi-structured interviews. The research population included administrators and supervisors of nursing, medical records and accreditation in educational hospitals in Ahvaz, southwest Iran. Content analysis method was used to analyze the data. Descriptive statistics were used to present demographic characteristics of interviewees.RESULTS:Facilitators and barriers to improve the quality of documentation were categorized into three levels: organizational, environmental, and personal, all achieved after the implementation of accreditation model in hospitals. Six facilitating factors were identified including organizational structure, organizational culture, management support, individual characteristics, and perceived benefits science and technology. The barriers included five factors including program structure, organizational structure, beliefs, justice, and individual characteristics.CONCLUSIONS:The identification of factors affects the quality of medical record documentation and it seems that health managers and policymakers should take measures to improve the quality of medical recording documentation through strengthening the facilitators and overcoming the barriers in the program since the purpose of accreditation is to improve the quality in hospitals.

Clinician and Early Childhood Educator Knowledge and Advice Given to Parents Regarding Physical Activity, Screen Time and Sleep. An Observational Study

Background: Global guidelines regarding infant physical activity, screen time and sleep were released by the World Health Organisation in 2019. Clinician and Early Childhood Educator (ECE) knowledge and advice given to parents regarding this content is unknown. The aims of this study were to determine the advice given to parents regarding infant care. This will enable a baseline from which future interventions and multidisciplinary professional development can be compared and reviewed. Methods: 80 Clinicians (Medical, Nursing, Allied Health) and ECE from a local health district in NSW Australia completed an online survey. Medical records (N=272) were also reviewed to determine if the documentation included advice in accordance with guidelines. Results: Staff were aware that infant guidelines contribute to positive health outcomes (all >85%). Nursing entered the most information into the medical record with >80% of files containing general advice about infant physical activity and sleep. Only 30% of entries contained evidence of guideline specific information. Minimal entries from all clinicians contained information about screen time (2%). Conclusions: The majority of clinicians and ECE were aware of the content of the guidelines and the advice they report to provide is consistent. Medical record documentation regarding the specificity of advice provided is lacking.

Comparison of the quality of documentation between electronic and paper medical records in orthopaedic trauma patients.

Objective The medical record is critical for documentation and communication between healthcare professionals. This study compared the completeness of orthopaedic documentation between the electronic medical record (EMR) and paper medical record (PMR). Methods A review was undertaken of 400 medical records (200 EMR, 200 PMR) of patients with operatively managed traumatic lower limb injury. The operative report, discharge summary and first and second out-patient reviews were evaluated using criteria designed by a senior orthopaedic surgeon and senior physiotherapist. The criteria included information deemed critical to the post-operative care of the patient in the first 6 weeks post-surgery. Results In all cases, an operative report was completed by a senior surgeon. Notable findings included inferior documentation of patient weight-bearing status on the operative report in the EMR than PMR group (P = 0.018). There was a significant improvement in the completion of discharge summaries in the EMR compared with PMR cohort (100% vs 82.5% respectively; P < 0.001). In the PMR group, 70.0% of discharge summaries were completed and adequately documented, compared with 91.5% of those in the EMR group (P < 0.001). At out-patient review, there was an improvement in documentation of weight-bearing instructions in the EMR compared with PMR group (81.1% vs 76.2% respectively; P = 0.032). Conclusion The EMR is associated with an improvement in the standard of orthopaedic medical record documentation, but deficiencies remain in key components of the medical record. What is known about the topic? Medical records are an essential tool in modern medical practice and have significant implications for patient care and management, communication and medicolegal issues. Despite the importance of comprehensive documentation, numerous examples of poor documentation continue to be demonstrated. Recently, significant changes to the medical record in Australia have been implemented with the conversion of some hospitals to an EMR and the implementation of the My Health Record. What does this paper add? Standards of patient care should be monitored continuously and deficiencies identified in order to implement measures for improvement and to close the quality loop. This study has highlighted that although there has been improvement in medical record keeping with the implementation of an EMR, the standard of orthopaedic medical record keeping continues to be below what is expected, and several key areas of documentation require improvement. What are the implications for practitioners? The implications of these findings for practitioners are to highlight current deficiencies in documentation and promote change in current practice to improve the quality of medical record documentation among medical staff. Although the EMR has improved documentation, there remain areas for further improvement, and hospital administrators will find these observations useful in implementing ongoing change.

Medical Records Documentation of HIV/AIDS Clinical Services at Primary Health Care (PHC) Facilities and Its Implications on Continuum of Care and Operational Research in South Africa

Background: Patients medical records are used to document care processes for communication amongst healthcare workers for continued patient management. Incomplete or inaccurate documentation can adversely affect the quality of patients’ care, leading to medication and treatment errors, increased morbidity, and mortality. Quality documentation in medical records is therefore an essential component of optimal healthcare and facilitates an individual’s continuity of care. This study aimed to assess the quality of documentation of clinical data through the review of the accuracy and completeness of clinical records among newly diagnosed HIV-positive persons. The study is a sub analysis of a prospective longitudinal study that followed a cohort of 12,413 persons who were newly diagnosed with HIV infection. Severe limitations in retrieving reliable information and data became an obstacle to our research and led the study team to conduct medical records documentation and data audit to verify the accuracy and completeness of the data for newly diagnosed HIV positive persons. Methods: A cross-sectional study was conducted using routine data generated from 75 randomly selected newly diagnosed HIV positive persons aged 12-years-old and above between June 1, 2014 and March 31, 2015 in 36 purposively selected primary health care (PHC) clinics in South Africa. The facilities were selected from three high HIV-burden districts of South Africa (Gert Sibande, uThukela and City of Johannesburg). Results: Significant differences in the accuracy and completeness of clinical records were observed between data generated through the self-assessment by the facility managers and data primarily collected through review of the patients’ clinical stationery and facility registers. 80% of the newly diagnosed HIV positive persons were not documented as screened for tuberculosis (TB) on the clinical chart and 69% of newly diagnosed clients were not clinically staged (WHO staging). Furthermore, 80% of newly diagnosed HIV positive persons’ follow up visit dates were not documented in the patient’s clinical chart. Completeness of the data elements on the case record forms ranged from as low as 26% to a maximum of 66%. It was noteworthy that all the clients’ information documented in HIV counselling and testing registers, continuum of care registers and clinical charts were only partially completed. Conclusion: Each of the health care facilities under study had some significant gaps in medical records documentation of clinical data on newly diagnosed HIV positive persons. Data and information accuracy and completeness were a serious challenge in most facilities during the period under investigation. Of interest was the inconsistency of data recorded in the HCT registers, continuum of care and clinical charts of individual patients. This is a major impediment to HIV/AIDS comprehensive care.

Impact of Patient Load on the Quality of Electronic Medical Record Documentation.

Objective:American College of Graduate Medical Education (ACGME) recommends ongoing care of 10 patients per resident however its implication is unclear. We hypothesized EMR quality to vary based on patient load and call status.Methods:We conducted a double-blind, single-center, retrospective observational study between 2017 and 2019 to investigate the quality and accuracy of resident documentation using the Responsible Electronic Documentation (RED) Checklist, a validated scoring system.Results:A total of 234 independent charts were analyzed and 80 met scoring criteria. Average patients per residents was 4, 9.1, 7.2, and 5.5 on “call” day (D0), “post-call” day (D1), “mid-call” day (D2), and “pre-call” day (D3), respectively. Mean RED checklist scores were 68.1%, 57%, 68.6%, and 72.1% on the above call status. The difference in score between D3 and D1 was statistically significant (P = .00042). There was a negative correlation between score and number of patients per resident (r = −0.286, P = .010).Conclusion:EMR documentation quality is directly impacted by patient load and resident call status with the lowest documentation quality on post-call day, correlating with patient load.

A quality improvement project to standardize chaplain documentation in the electronic medical record

Medical record documentation by hospital chaplains is an under-researched and under-published field. Because documentation serves both as a register of chaplain interventions and as a collaborative tool for interdisciplinary communication, it should be written in a way that is clear, concise, and consistent. As chaplains continue to integrate with other medical professions in interdisciplinary care, careful attention should be given to the way in which communication of the chaplain role, functioning, and patient information obtained is conveyed. This quality improvement project standardized chaplain documentation in one health system of 15 medical centers, provides insights and resources devised from the project, and offers considerations for other systems contemplating future changes toward standardizing documentation.

The Feasibility of Magnetic Resonance Imaging for the Differentiation of Cerebrospinal Fluid Leak From Middle Ear Effusion: A Quantitative Analysis.

Assess quantitatively whether magnetic resonance imaging (MRI) signal intensity can be used to distinguish cerebrospinal fluid (CSF) leaks in the temporal bone from middle ear effusions. Retrospective case review. Tertiary referral center. Forty-nine patients, 18 with middle ear effusions (MEE), 30 with CSF leaks, and 1 with an MEE on one side and a CSF leak on the other, were evaluated in the study. Primary inclusion criteria for CSF leak patients were operative management of CSF leak with confirmatory diagnosis in follow-up. Primary inclusion criteria for MEE patients were electronic medical record documentation of an effusion with subsequent resolution on follow-up. For all patients, inclusion criteria included MRI imaging with 3D-T2 weighted sequences (3DT2) and fluid-attenuated inversion recovery (FLAIR) sequences performed within 1 year of diagnosis code entry. Computational analysis of signal intensity of fluid collections in MRI imaging. Sensitivity and specificity of 3DT2 and FLAIR signal intensity in the detection of CSF leak. For 3DT2 sequences with a chosen normalized signal intensity threshold (CSF leak if ≥ 0.5), sensitivity was 100% (95% CI: 86.3-100) and specificity was 83.3% (95% CI: 51.6-97.9). For FLAIR sequences with a threshold of 1.0 (CSF leak if < 1.0), sensitivity was 77.4% (95% CI: 58.9-90.4) and specificity was 85.7% (95% CI: 63.6-97.0). For a combined test in which a fluid collection was considered CSF if both 3DT2 ≥ 0.5 and FLAIR < 1.0, sensitivity was 76% (95% CI: 54.9-90.6) and specificity was 100% (95% CI: 73.5-100).

Verification of administrative data to measure palliative care at terminal hospital stays.

Administrative data and clinician documentation have not been directly compared for reporting palliative care, despite concerns about under-reporting. The aim of this study was to verify the use of routinely collected administrative data for reporting in-hospital palliation and to examine factors associated with coded palliative care in hospital administrative data. Hospital administrative data and inpatient palliative care activity documented in medical records were compared for patients dying in hospital between 1 July 2017 and 31 December 2017. Coding of palliative care in administrative data is based on hospital care type coded as "palliative care" and/or assignment of the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian Modification (ICD-10-AM) palliative care diagnosis code Z51.5. Medical records were searched for specified keywords, which, read in context, indicated a palliative approach to care. The list of keywords (palliative, end of life, comfort care, cease observations, crisis medications, comfort medications, syringe driver, pain or symptom management, no cardiopulmonary resuscitation, advance medical plan/resuscitation plan, deteriorating, agitation, restless and delirium) was developed in consultation with seven local clinicians specialising in palliative care or geriatric medicine. Of the 576 patients who died in hospital, 246 were coded as having received palliative care, either solely by the ICD-10-AM diagnosis code Z51.5 (42%) or in combination with a "palliative care" care type (58%). Just over one-third of dying patients had a palliative care specialist involved in their hospital care. Involvement of a palliative care specialist and a cancer diagnosis substantially increased the odds of a Z51.5 code (odds ratio = 11 and 4, respectively). The majority of patients with a "syringe driver" or identified as being at the "end of life" were assigned a Z51.5 code (73.5% and 70.5%, respectively), compared to 53.8% and 54.7%, respectively, for "palliative" or "comfort care." For each keyword indicating a palliative approach to care, the Z51.5 code was more likely to be assigned if the patient had specialist palliative care input or if they had cancer. Our results suggest administrative data under-represented in-hospital palliative care, at least partly due to medical record documentation that failed to meet ICD-10-AM coding criteria. Collaboration between clinicians and coders can enhance the quality of records and, consequently, administrative data.

A Prospective Sonographic Evaluation of Peripheral Intravenous Catheter Associated Thrombophlebitis

Objective: Thrombophlebitis associated with peripheral intravenous catheters (PIVCs) is a poorly described complication in the literature. Given limited accuracy of current assessment tools and poor documentation in the medical record, the true incidence and relevance of this complication is misrepresented. We aimed to identify risk factors in the development of thrombophlebitis using an objective methodology coupling serial diagnostic ultrasound and clinical assessment. Methods: We conducted a single-site, prospective observational cohort study. Adult patients presenting to the emergency department that underwent traditionally placed PIVC insertion and were being hospitalized with an anticipated length of stay greater than two days were eligible participants. Using serial, daily ultrasound evaluations and clinical assessments via the phlebitis scale, we identified patients with asymptomatic and symptomatic thrombosis. The primary goal was to identify demographic, clinical, and IV related risk factors associated with thrombophlebitis. Univariate and multivariate analyses were employed to identify risk factors for thrombophlebitis. Results: 62 PIVCs were included between July and August 2020. 54 (87.10%) developed catheter-related thrombosis with 22 (40.74%) of the thrombosed catheters were characterized as symptomatic. Multivariate cox regression demonstrated that catheter diameter relative to vein diameter greater than one-third [AHR 5.41 (1.91, 15.4) P = 0.0015] and angle of distal tip of catheter against vein wall ≥ 5 degrees [AHR 4.39 (1.39, 13.8) P = 0.0116] were associated with increased likelihood of thrombophlebitis. Conclusions: Our study found that the increased proportion of catheter relative to vein size and steeper catheter tip angle increased the risk of thrombophlebitis. Catheter size relative to vein size is a modifiable factor that should be considered when inserting PIVCs. Additional larger prospective investigations using objective methodologies are needed to further characterize complications in PIVCs. Funding Statement: There is no funding source for this study. Declaration of Interests: All authors (AB, SJ, PK, NM) have nothing to disclose. There are no relevant conflict of interest disclosures relevant to the research, authorship, and/or publication of this article. Ethics Approval Statement: The Institutional Review Board (IRB) at our institution approved this study.

Kelengkapan Informasi Medis Dalam Penetapan Kode Morbiditas, Pada Kasus Chronic Kidney Disease Di Rumah Sakit Panti Wiloso Dr Cipto Semarang

Observations were made on the medical record documents of the Chronic Kidney Disease (CKD) case, found incomplete medical information, namely the results of X-rays of 70%, other tests of 20%, writing of disease history of 10% and some of the stages of disease were not written. The results of the interview with one of the coders were due to the lack of accuracy in filling in medical supporting data. The aim of the study was to describe the medical information in determining morbidity coding in CKD cases. Using a quantitative descriptive research approach, data from observations of 63 documents of CKD inpatient medical records were completed with information from one of the inpatient coder officers. The results showed that, there was still incomplete medical information such as the results of investigations and medical history. And several documents were found whose examination result sheets were not in DRM. The procedure for determining the code in the RS Panti Wilasa Dr Cipto in the CKD case did not differ in giving morbidity codes with other cases. The flow is in accordance with the implementation guidelines for coding in ICD 10 Revision 2010. However, in determining the code the main obstacle is the lack of clarity in writing medical diagnoses, and there is an incomplete history. The conformity of the morbidity code based on ICD-10 version 2010 in the case of CKD in Dr Cipto Panti Wilasa Hospital was 71.42% and the code mismatch was 28.58%. This is due to incomplete medical information and unclear stages of CKD disease. It is advisable for the coder to confirm to the DPJP if there is a diagnosis that is illegible or less specific so that the code generated is appropriate and precise, especially in the diagnosis of CKD. The need to complete medical information and double-check medical record documents before coding. Keywords: Medical Record Documents, Chronic Kidney Diseases, Morbidity Code, ICD-10

Medical Record Documentation System in Ethiopia

Due to the lack of related symptoms and the hypersecretion of serum hormones, it is difficult to monitor and predict the postoperative recurrence of non-functioning pituitary adenomas (NFPAs). Long noncoding RNAs (lncRNAs) and protein-coding genes (PCGs) play critical roles in the development and progression of many tumors. However, the complex network of RNA interactions related to the mechanism and function of the postoperative recurrence of NFPA is still unclear.

Multisite quality improvement initiative to repair incomplete electronic medical record documentation as one contributor to provider burnout.

190 Background: Provider burnout is a challenge adversely affecting the quality, safety, and cost of health care. We measured burnout among pediatric oncology providers in the St. Jude Affiliate network and used a Plan-Do-Study-Act (PDSA) improvement cycle to address one of the factors contributing to burnout. Methods: Within the framework of the American Society of Clinical Oncology (ASCO) Thematic Quality Training Program (QTP) we sent the Mini Z 2.0 Survey to 47 pediatric oncology providers. Applying a fishbone diagram and Pareto chart we analyzed potential causes of provider burnout. Based on the analysis, we used a PDSA approach to address documentation of oral chemotherapy adherence for children with acute lymphoblastic leukemia to mitigate burnout among providers. Results: The burnout survey response rate was 44.6%. Burnout was identified in 42.9% of providers. Documentation in the electronic medical record (EMR) was cited as the second most common contributor to burnout, and it was this issue we chose to address based on a priority matrix. We improved the completeness of oral chemotherapy documentation from a baseline of 13% compliance to 87% compliance within 3 months. The improved compliance was achieved by standardizing the documentation process in the EMR for content and location. Conclusions: The EMR was one of the contributing factors in the burnout survey of the pediatric oncology providers in the St. Jude Affiliate network. A PDSA improvement model to improve clinical research documentation was successful in addressing one of several contributing factors to provider burnout.

Impact of a Standardized EMS Handoff Tool on Inpatient Medical Record Documentation at a Level I Trauma Center

Background The emergency department (ED) poses challenges to effective handoff from emergency medical services (EMS) personnel to ED staff. Despite the importance of a complete and accurate patient handoff report between EMS and trauma staff, communication is often interrupted, incomplete, or otherwise ineffective. The Mechanism of injury/Medical Complaint, Injuries or Inspections head to toe, vital Signs, and Treatments (MIST) report initiative was implemented to standardize the handoff process. The objective of this study was to evaluate whether documentation of prehospital care in the inpatient medical record improved after MIST implementation. Methods Research staff abstracted data from the EMS and inpatient medical records of trauma patients transported by EMS and treated at a Level I trauma center from January 2015 through June 2017. Data included patient demographics, mechanism and location of injury, vital signs, treatments, and period of data collection (pre-MIST and post-MIST). We summarized the MIST elements in EMS and inpatient medical records and assessed the presence or absence of data elements in the inpatient record from the EMS record and the agreement between the two sets of records over time to determine if implementation of MIST improved documentation. Results We analyzed data from 533 trauma patients transported by EMS and treated in a Level I trauma center (pre-MIST: n = 281; post-MIST: n = 252). For mechanism of injury, agreement between the two records was ≥96% before and after MIST implementation. Cardiac arrest and location of injury were under-reported in the inpatient record before MIST; post-MIST, there were no significant discrepancies, indicating an improvement in reporting. Reporting of prehospital hypotension improved from 76.5% pre-MIST to 83.3% post-MIST. After MIST implementation, agreement between the EMS and inpatient records increased for the reporting of fluid administration (45.6% to 62.7%) and decreased for reporting of pain medications (72.2% to 61.9%). Conclusions The use of the standardized MIST tool for EMS to hospital patient handoff was associated with a mixed value on inpatient documentation of prehospital events. After MIST implementation, agreement was higher for mechanism and location of injury and lower for vital signs and treatments. Further research can advance the prehospital to treatment facility handoff process.

Pilot Testing a Bedside Patient Safety Display to Increase Provider Awareness of the ‘Hidden Hazards’ of Catheters and Wounds

Background: Urinary catheters, vascular catheters, and wounds, such as pressure injuries are often hidden from view under gowns and sheets (ie, out of sight, out of mind), contributing to prolonged catheter use, infections, delayed interventions, and diagnostic errors for symptoms (eg, fever or delirium) related to catheters and wounds. We developed and pilot tested a digital bedside Patient Safety Display of catheter and wound information to improve awareness by rounding providers (ie, physicians and advanced practice providers, APPs). Methods: The display development was informed by clinical observations of provider rounds and nurse handoffs, interviews, and iterative prototype testing with clinicians in simulated cases using catheterized mannequins with wounds. The display reports the presence and duration of urinary and vascular catheter use, urinary catheter indication, and wound presence and severity, from real-time mandatory nurse documentation in the electronic medical record (Fig. 1). We conducted a pilot study in a tertiary-care medical-surgical step-down unit with 20 private rooms, including a preintervention period and a postintervention period including 10 rooms without the display (control rooms) and 10 rooms with the display (intervention rooms). We surveyed individual providers directly after rounds to assess their awareness of their patients’ catheters and wounds compared to medical record documentation. We also assessed display utility and usability from postintervention clinician interviews and we identified major themes using an adapted grounded theory approach. Results: In total, 787 surveys were completed: 681 medicine service with 89% response rate, 106 surgery service with 47% response rate; 363 preintervention surveys, and 424 postintervention surveys. The surveys involved 176 unique patients and 47 unique providers. Among all 787 patient encounters, 156 (19.8%) had a transurethral indwelling urinary catheter (Foley), 314 (39.9%) had a central venous catheter (including PICCs), and 247 (31.4%) had at least 1 pressure injury. Figure 2 summarizes provider awareness of catheters and pressure injuries when present as assessed for patients in the preintervention and postintervention periods. Moreover, 13 clinician postintervention interviews yielded preliminary themes regarding the display’s benefits and limitations (Fig. 3). Conclusions: In this pilot study of a novel Patient Safety Display, although provider awareness of Foley catheters, CVCs, and pressure injuries appeared higher for patients in the intervention rooms compared to awareness as measured in the preintervention rooms and/or postintervention control rooms, most of these comparisons did not meet statistical significance. Clinicians varied widely in their personal assessments of the display as a useful tool for improving awareness and prompting discussion about catheters and wounds.Funding: This work was funded by the Agency for Healthcare Research and Quality (AHRQ) grant P30HS024385. Dr. Meddings’ effort was initially partially funded by concurrent support from AHRQ (K08 HS19767).Disclosures: Dr. Meddings has reported receiving honoraria for lectures and teaching related to prevention and value-based purchasing policies involving catheter-associated urinary tract infection. The remaining authors report no conflicts of interest.

Improved Postoperative Outcomes By Utilizing A Comprehensive Perioperative Surgical Site Infection (SSI) Reduction Bundle

Background: Surgical site infections (SSIs) can be attributed to increased patient morbidity and mortality, prolonged hospital stays, and overall increased healthcare costs. The Surgical Care Improvement Project (SCIP) was implemented in 2002 but has made limited impact on SSI rates across our facilities, which has led to the creation of a bundled approach of current evidence-based strategies. Methods: In January 2019, a comprehensive SSI prevention bundle of strategies was implemented across a multihospital health system. The bundle was comprised of 8 interventions focusing on the preoperative, intraoperative, and postoperative continuum of care, and refining documentation in the electronic medical record. From January to September 2019 (preointervention period), data were collected from 7,163 adult inpatient and observation elective patients undergoing colon surgery (COLO), abdominal hysterectomy (HYST), hip arthroplasty (HPRO), knee arthroplasty (KPRO), and cardiac bypass graft (CBGB/CBGC). The preintervention period for SSI standardized infection ratios (SIRs) and retrospective review of process measures was set as January–December 2018 (postintervetnion period). Each process measure had outlined targets along with primary outcome measures of overall SSI SIRs and SIRs for each of the 5 reported procedure categories. SSIs were validated to meet CDC and NHSN surveillance case definitions. Secondary outcomes evaluated included length of stay (LOS), readmission rates, and mortality. Results: Overall SIR for all 5 monitored surgical categories decreased by 5% to 1.131 from January to September 2019, compared to SIR of 1.190 in 2018. Hip and knee arthroplasties demonstrated 40% and 38% reductions after the intervention, respectively. Completion of 7 or 8 interventions of the SSI bundle were correlated with lower readmission rates (P = .0488). When any portion of the bundle was used, this was correlated with shorter LOS (P &lt; .0001). Adherence to standardized antimicrobial prophylaxis was associated with decreased mortality (P = .017), for all 5 surgical categories. Conclusions: With the implementation of a focused SSI reduction bundle, our institution has realized reductions in surgical readmissions, length of stay, and mortality. Additionally, SSI rates in certain procedure categories have shown marked improvement. The initial success of this bundle has garnered development of additional procedure focused supplemental strategies for the future year.Funding: NoneDisclosures: Aarikha D’Souza, Banner Health