Editor’s note: The Society of Hospital Medicine’s (SHM’s) Physician in Training Committee launched a scholarship program in 2015 for medical students to help transform health care and revolutionize patient care. The program has been expanded for the 2017-18 year, offering two options for students to receive funding and engage in scholarly work during their first, second and third years of medical school. As a part of the longitudinal (18-month) program, recipients are required to write about their experience on a monthly basis.
It truly has been a rewarding experience participating in a quality improvement project and I am excited to see what the future holds. Our project, “Reducing CAUTI with Noninvasive UC Alternatives and Measure-vention,” aimed to combat catheter associated urinary tract infections, with a three-pronged approach: by reducing UC placement, performing proper maintenance of IUC, and ensuring prompt removal of unnecessary UC.
In addition, we aspired to improve staff knowledge and behavior regarding IUC management, and reduce patient discomforts and infectious/noninfectious harms of IUC by emphasizing IUC alternatives. At the outset of the project, our primary outcome measure of interest was CAUTI rate (both per patient day and per IUC day) as well as the percentage IUC utilization rate.
To date, our project has demonstrated qualitative success. Specifically, we have implemented a pipeline to perform “measure-vention,” or real-time monitoring and correction of defects. The surgical care intensive unit (SICU) was identified as an appropriate candidate for a pilot partnership due to its high utilization of UC. A daily report of patients with UC is generated and then checked against the EMR for UC necessity. Subsequently, we contact the unit RN for details and physicians for removal orders, when possible. Simultaneously, this enables us to reinforce our management bundle in real time. This protocol is being effectively implemented in the SICU and we are hoping to expand to other units as well. Quantitative data collection is still ongoing and hopefully forthcoming.
Previous CAUTI reduction efforts have had variable and partial success. We are very excited to have improved noninvasive IUC alternatives that address staff concerns about incontinence workload, urine output monitoring, and patient comfort. We hope to protect our patients from harm and eventually publicize our experience to help other health care facilities reduce IUC use and CAUTI.
It has been a rewarding experience to participate in a quality improvement project and I am enjoying the challenges of collaborating with a diverse team of medical professionals to improve the patient experience.
Victor Ekuta is a third-year medical student at UC San Diego.