Infection Control & Hospital Epidemiology
This brings us back to our titular question derived from Shakespeare: Would a rose by any other name really smell as sweet? We believe the answer is no—our language and framing matter. Being thoughtful in our communication ensures that we are including all our stakeholders, accurately framing our work in a positive light, and correctly describing the work we do—all are critical components of our work in infection prevention.
Financial support. No financial support was provided relevant to this article.
Potential conflicts of interest. All authors report no conflicts of interest relevant to this article.
References
1. Abadi M. Democrats and Republicans speak different languages—and it helps explain why we’re so divided. Business Insider website. http://www.
businessinsider.com/political-language-rhetoric-framing-messaging-lakoff- luntz-2017-8. Published August 2017. Accessed February 19, 2018.
2. Chapman S. Other people’s smoke: What’s in a name? Tobacco Control 2003;12:113–114.
3. Stewart AE, Lord JH. Motor vehicle crash versus accident: a change in terminology is necessary. J Trauma Stress 2002;15:333–335.
4. Richtel M. It’s no accident: advocates want to speak of car ‘crashes’ instead. The New York Times website.
https://www.nytimes.com/2016/05/23/ science/its-no-accident-advocates-want-to-speak-of-car-crashes-instead. html. Published May 22, 2016. Accessed April 2, 2018.
Promoting an action plan for devices in the emergency department—does it impact catheter duration?
Bernard Surial MD1,2, Andrew Atkinson1, Susanne Nüesch MD3, Joerg C. Schefold MD4 and Jonas Marschall MD1 1Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland, 2Department of Internal Medicine, Inselspital, Bern
University Hospital, University of Bern, Switzerland, 3Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland and 4Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
To the Editor—Urinary catheters, arterial lines, and central venous catheters (CVCs) are frequently placed in emergency departments (EDs). However, because many devices are inserted for inappropriate and poorly documented reasons,1,2 physicians on the receiving hospital floors are often unaware of their pre- sence and indication, which can lead to unnecessarily long catheterization.3 We hypothesized that if the indication and anticipated duration were explicitly stated in the ED discharge report, subsequent care providers would be more aware of these devices in place and could decide more confidently whether to remove them. This information could increase appropriate use, shorten the duration of catheterization, and thereby reduce device-associated complications. We conducted an intervention study in a 950-bed university
hospital in Switzerland, where we included all patients admitted to the hospital with a device (ie, urinary catheter, arterial line, or CVC) placed in our 30-bed ED. Patients with devices placed before ED arrival and patients transferred to another hospital were excluded. We captured data during a preinterven- tion period (July 2016–March 2017) and an intervention period (April–June 2017). Because this study was part of a quality improvement project, no institutional review board approval was required. During the intervention period, all ED physicians were asked
to include in the ED discharge report an action plan for each inserted device with (1) the type of device, (2) the indication for its placement, (3) the anticipated duration. Our infection pre- vention team held a meeting at the beginning of the intervention, posted indication sheets in the ED work area, and sent weekly e-mail reminders with pertinent information. The timing of this
Author for correspondence: Bernard Surial, MD, Department of Infectious Diseases,
Inselspital, Bern University Hospital, Freiburgstrasse 18, CH-3010 Bern, Switzerland. E-mail:
Benard.Surial@
insel.ch
Cite this article: Surial B, et al. (2018). Promoting an action plan for devices in the
emergency department—does it impact catheter duration? Infection Control & Hospital Epidemiology 2018, 39, 1011–1012. doi: 10.1017/ice.2018.132
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
period was aligned with the baseline surveillance of a national pilot program aimed at reducing urinary catheter utilization and its complications with bundled interventions.4 The primary outcome was duration of device placement before
and after the intervention. Secondary outcomes were device inser- tion rates and compliance with the intervention requirements. Electronic health records were used to identify eligible patients and to obtain demographic data including time of device placement and removal. All ED discharge reports during the intervention period were reviewed to determine whether a device-related action plan was proposed. Continuous data are presented as median (interquartile range, IQR), and categorical data are presented as numbers and percentages. We compared continuous variables using theWilcoxon rank-sum and Kruskal-Wallis tests and proportions using the χ2 test. Data analyses were performed using R Studio software.5 During the study period, 1,346 devices were inserted in ED
patients admitted to our hospital. Most were urinary catheters (n=771, 57.3%) and arterial lines (n=528, 39.2%), and a few were CVCs (n=47, 3.5%). Most patients were male (n=805, 59.8%) with a median age of 70 years (IQR, 55.0–79.0) and were admitted to the intensive care unit at some point during their hospitalization (n=979, 72.7%). Table 1 summarizes the catheter durations and their insertion rates. The median duration of urinary catheters was 70.2 hours (35.7–138.0); the median dura- tion of arterial lines was 40.2 hours (20.6–75.4); and the median duration of CVC was 78.8 hours (25.5–163.5). Neither overall duration of catheterization nor that of individual devices decreased over time. A device was placed in 10.2% of all admitted ED patients.
Urinary catheters were placed in 5.9%, followed by arterial lines in 4.0%, and CVC in 0.4% of all patients. Although the overall insertion rates did not change after the intervention, we observed increased use of arterial lines in the intervention period (P=.01). During the intervention period, devices were mentioned in 102 ED discharge reports (29.6%); a complete action plan was present in 35 cases (10.1%). The median duration of devices with an
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