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Submitted on September 2, 2006
Accepted on February 8, 2007
Affiliation of the authors: 1 Department of Care Management and Outcomes Research, Parkland Health and Hospital System, Dallas, TX; Department of Medicine, University of Texas Southwestern Medical School, Dallas, TX ; 2 Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD ; 3 Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD ; 4 Michigan Health and Hospital Association, Keystone Center for Patient Safety and Quality, Detroit, MI ; 5 Department of Cardiology School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Health Sciences Informatics, School of Medicine, Johns Hopkins University, Baltimore, MD; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD ; 6 Department of Medicine, University of Texas Southwestern Medical School, Dallas, TX; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University School of Medicine, Baltimore, MD
* To whom correspondence should be addressed.
Objective Few instruments are available to measure the performance of intensive care unit (ICU) clinical information systems. Our objectives were: 1) to develop a survey-based metric that assesses the automation and usability of an ICU's clinical information system; 2) to determine whether higher scores on this instrument correlate with improved outcomes in a multi-institution quality improvement collaborative.
Design This is a cross-sectional study of the medical directors of 19 Michigan ICUs participating in a state-wide quality improvement collaborative designed to reduce the rate of catheter-related blood stream infections (CRBSI). Respondents completed a survey assessing their ICU's information systems.
Measurements The mean of 6o summed items on this instrument yields the clinical information technology (CIT) index, a global measure of the ICU's information system performance on a 100 point scale. The dependent variable in this study was the rate of CRBSI after the implementation of several evidence-based recommendations. A multivariable linear regression analysis was used to examine the relationship between the CIT score and the post-intervention CRBSI rates after adjustment for the pre-intervention rate.
Results In this cross-sectional analysis, we found that a 10 point increase in the CIT score is associated with 4.6 fewer catheter related infections per 1,000 central line days for ICUs who participate in the quality improvement intervention for 1 year (95% CI: .09 to 7.9).
Conclusions This study presents a new instrument to examine ICU information system effectiveness. The results suggest that the presence of more sophisticated information systems was associated with greater reductions in the bloodstream infection rate.
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