(1274) Reducing Central Line Utilization and Infections Through BPA-Driven Interventions in EPIC EHR

Introduction: Central line-associated bloodstream infections (CLABSIs) are a significant cause of morbidity and mortality in hospitalized patients. Reducing the duration of central line usage is critical in minimizing the risk of CLABSIs. This quality improvement project aimed to decrease central line days, the device utilization ratio (DUR = # of central line days/ # of patient days), and the standardized infection ratio (SIR = # of observed CLABSIs/# of Predicted CLABSIs) through the implementation of a Best Practice Advisory (BPA) for central line removal in the electronic health record (EPIC EHR).

Methods: The project was conducted in a tertiary care hospital between September 2022 and April 2024. A multidisciplinary team developed and implemented two BPAs within EPIC that alerted the provider if the patient has a central line that could potentially be removed. The BPAs were implemented in August 2023. Data on central line days, patient days, DUR, and CLABSI SIR were collected pre- and post-implementation of the BPA.

Results: A total of 4900 patients were included (2450 before and 2450 after the intervention). The before and after groups had similar age (61 +/- 18 vs 61 +/- 18, p = 0.1.0), gender ( Male: 53 % vs 51 %, p = 0.2), APACHE IV scores (53 +/- 27 vs 52 +/- 26, p = 0.2), acute physiologic scores (APS: 41 +/- 25 vs 40 +/- 23, p = 0.2), ICU length of stay (ICU LOS: 3.6 +/- 4.2 vs 3.6 +/- 4.0, p = 1.0), and hospital LOS (10.2 +/- 10 vs 9.9 +/- 9.2) respectively. Compared to before group, the after group had less DUR (0.31 vs 0.39, p = 0.0001), CLABSI SIR (0.24 vs 1.05, p = 0.0001), ICU mortality (9.6 % vs 12 %, p = 0.007), and hospital mortality (14 % vs 20 %, p = 0.001).

Conclusions: The introduction of BPAs for central line removal effectively reduced central line DUR, and CLABSI SIR in a large hospital setting. This intervention demonstrates the potential of health information technology to enhance patient safety by promoting best practices and reducing the risk of CLABSIs. The observed reductions in ICU and hospital mortality further highlight the clinical benefits of the BPA. Further studies are recommended to evaluate long-term sustainability and to optimize strategies for central line management.