Lessons learned from the Field: Successful Strategies in the Emergency Department (1305)

1. Lessons learned from the Field: Successful Strategies in the Emergency Department (1305) Originally presented by Jeremiah S Schuur, MD, MHS, Patient Safety and Performance Improvement for the Dept. of Emergency Medicine, Brigham and Women’s Hospital, Boston MS Eileen Carter, RN, BSN, Doctoral Candidate, Columbia School of Nursing, New York, NY Summarized by Cheryl Flesner, RN, CIC

2. ED is an Important Setting for HAIs • ED is the front door of the hospital • ½ of hospital admissions originate in the ED • 130 million ED visits per year. • Over 2 million ICU admissions • 20% of US population visited an ED at least once in 2010 • Top diagnosis is URI and flu. • Lots of invasive procedures • central venous catheters • urinary catheters • endotracheal intubation

4. ED is an Important Setting for HAIs • Multiple patients in close proximity separated by curtains or in hallway • >50 % of EDs report insufficient space • >80% report number of patients exceeded ED staffing • Many staff with no formal training: Registrar, security, EVS, volunteers. • ED Culture: • Prioritized urgent intervention over prevention • Values decisive action over precautions and circumspection • Chronic crowding and chaos “normalizes deviancy”

7. The perfect storm

12. CAUTI Case Study • Description • Large community hospital in Midwest. You perform CAUTI RCA and find that: • Majority of patients with CAUTI had foleys inserted in ED • Many ED-placed urinary catheters are avoidable • ED nurses report using sterile technique during foley insertion, but insertion technique is not formally or routinely evaluated. • No CAUTIs are assigned to ED (they are assigned to inpatient locations)

15. We avoided using a foley catheter. Another CAUTI prevented!