A complete and accurate reporting of all hospital-acquired infections (HAIs) is critical in pediatric care as HAIs are associated with longer hospital stays, longer ventilation times, increased cost and adverse neuro-developmental outcomes in children. Electronic health records or EHRs are quite effective for reporting HAIs as they provide complete and easily accessible data. Many hospitals have leveraged EHR enabled workflows to reduce hospital acquired infections. Physician dictations still play an important role in the medical documentation process and these must be transcribed accurately. Providers can utilize medical transcription services that transcribe physician dictations, interface with the provider’s EHR system and post the transcripts onto the EHR. In this way clinicians can save the time wasted on transcribing and data entry tasks. There needn’t be any concern about security since the transcription and EHR integration is done via HIPAA-compliant portals.
Now let’s take a look at some research studies on utilizing EHR for the most common HAIs among children such as central line-associated blood stream infection (CLABSI), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infection (CAUTI).
A study conducted in the pediatric intensive care unit of the Lucile Packard Children’s Hospital Stanford found that a computerized safety checklist that can automatically pull information from patients’ electronic health records was effective in reducing the rates of central line-associated blood stream infection (CLABSI). A dashboard-style interface was used to interact with the automated checklist so that caregivers were able to easily and quickly follow the national guidelines for keeping patients’ central lines infection-free. This system explored the data within the EHR and prompted alerts to the physicians and nurses when a patient’s central line was due for care. It was found during the study that the rate of CLABSI in the pediatric ICU dropped from 2.6 to 0.7 per 1,000 days of central line use.
A program that uses the EHR was used in UC Davis Health System pediatric ICU to reduce VAP. It was found that this system reduced the rate of VAP from an average of 5.34 per 1000 patient days in CY 2010 to 0.60 in CY 2012 (82%). New clinical workflows were defined and embedded into the EHR before using it in the pediatric ICU. The creation of best practice online clinical knowledge in the EHR has contributed much to the effectiveness of the system.
CAUTI has not received that much attention as CLABSIs and ventilator-related pneumonia have. Still, a research study at Penn Medicine found targeted automated alerts in the EHR system significantly reduced urinary tract infections in patients with urinary catheters. In patients’ EHR, doctors were impelled to specify the reason for which they were inserting a urinary catheter. Based on their choice, they were alerted to reassess the need for the catheter if it had not been removed within the stipulated time specified. This pattern of creating alerts within the EHR can be used in the pediatric ICU as well.
From these three cases, it is evident that EHRs are effective in reducing HAI in pediatric care when the data within the system is complete and accurate. Keeping data accurate within EHR is challenging even with effective speech recognition systems since errors may occur due to temporary changes in the dictator’s sound (for example, due to cold) or noise from the environment. Most of the physicians overlook the data errors within the electronic record system while providing care to their patients. The service of health documentation specialists is very important for ensuring the accuracy of data including laboratory and clinical reports within the EHR.
