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Objective: Urine cultures collected from catheterized patients have a high likelihood of false-positive results due to colonization. We examined the impact of a clinical decision support (CDS) tool that includes catheter information on test utilization and patient-level outcomes. Methods: This before-and-after intervention study was conducted at 3 hospitals in North Carolina. In March 2021, a CDS tool was incorporated into urine-culture order entry in the electronic health record, providing education about indications for culture and suggesting catheter removal or exchange prior to specimen collection for catheters present >7 days. We used an interrupted time-series analysis with Poisson regression to evaluate the impact of CDS implementation on utilization of urinalyses and urine cultures, antibiotic use, and other outcomes during the pre- and postintervention periods. Results: The CDS tool was prompted in 38,361 instances of urine cultures ordered in all patients, including 2,133 catheterized patients during the postintervention study period. There was significant decrease in urine culture orders (1.4% decrease per month; P < .001) and antibiotic use for UTI indications (2.3% decrease per month; P = .006), but there was no significant decline in CAUTI rates in the postintervention period. Clinicians opted for urinary catheter removal in 183 (8.5%) instances. Evaluation of the safety reporting system revealed no apparent increase in safety events related to catheter removal or reinsertion. Conclusion: CDS tools can aid in optimizing urine culture collection practices and can serve as a reminder for removal or exchange of long-term indwelling urinary catheters at the time of urine-culture collection.

Background Standard urine culture collection techniques have a high risk of false positive results in catheterized patients. IDSA guidelines recommend replacing long-term catheters before specimen collection for cultures. Our goal was to evaluate the impact of clinical decision support (CDS) during the urine culture computerized provider order entry (CPOE) on test use and patient-level outcomes. Methods In March 2021, CDS was added to the urine culture CPOE in the electronic health record (EHR). The order panel includes education regarding appropriate clinical indications for urine culturing, and protocolizes urine collection to determine (A) if a urinalysis was ordered, (B) if special patient population (i.e., PICU), (C) the presence and duration of an indwelling urinary catheter, and (D) whether the catheter had difficulty with placement. Depending on the criteria identified in A, B, C, and D, the panel recommends catheter removal prior to urine culture (Figure 1). We retrospectively evaluated the impact of panel implementation in our pre- (7/2020- 3/2021) and post-intervention periods (4/2021- 3/2022) using an interrupted time series analysis with Poisson regression. Outcomes included urine cultures/1000 patient days (pd), number of catheter removal orders, catheter-associated urinary tract infection (CAUTI)/1000 catheter days, and days of antibiotic therapy with urinary tract infection (UTI) indication/1000pd Order Panel Framework Results Clinicians selected catheter removal in 183 of 2133 (8.5%) instances of ordering a urine culture when a catheter was detected by the panel (Figure 2). Analysis revealed a significant decrease in urine culture orders (1.1% decrease/month, p< 0.05), a decreasing trend of antibiotic use with UTI indications (Figure 3, 2.8% decrease/month, p< 0.05), but no significant change in CAUTI rates (Figure 4). Evaluation of the safety reporting system revealed no identifiable increase in safety events related to catheter removal or reinsertion. Catheter Associated Urinary Tract Infections Black boxes indicate Poisson regression model estimates Black boxes indicate Poisson regression model estimates Conclusion CDS can aid in improving urine culture practice habits, including removal of long-standing catheters before urine culture. The decreasing trend in total urine culture orders (Figure 5) may reflect a ”culture change” over time to avoid urine cultures in inappropriate instances. Total Urine Cultures Ordered Black boxes indicate Poisson regression model estimates. Red circles indicate predicted outcome without ‘intervention’. Disclosures Sonali D. Advani, MBBS, MPH, FIDSA, Locus Biosciences: Advisor/Consultant|Locus Biosciences: Honoraria|Sysmex America: Advisor/Consultant.

Our objective was to assess informed consent procedures for intravenous tissue plasminogen activator in acute stroke among New York State (NYS) Department of Health (DOH) designated stroke centers.A 13-question survey stratified by 0- to 3-hour and 3.0- to 4.5-hour treatment windows was used to determine the type of consent or if no consent was required.Of the 117 hospitals, 111 responded (95%). All 111 hospitals provided treatment within the 3-hour window, whereas 97 (87%) provided treatment beyond the 3-hour window (P .001). For hospitals that did provide treatment, there was a difference between the percentages of hospitals requiring consent (verbal or written) within 3 hours (82%) and beyond 3 hours (92%) (P = .04). Of the hospitals requiring consent, there was a difference in the type of consent: 31 of 91 (34%) required written consent within the 3-hour window, whereas 57 of 89 (64%) required written consent beyond the 3-hour window (P .001). Within both treatment windows, 98% accepted a health-care proxy or surrogate in lieu of the patient. Of the hospitals with less than 500 beds, 11 of 81 (14%) did not require consent within the 3-hour treatment window, compared to hospitals with 500 or more beds where 9 of 30 (30%) did not require consent within the 3-hour treatment window (P .05). Beyond the 3-hour treatment window, hospitals with more than 500 beds required written consent-2-fold increase "compared to less than 3 hour window" (P .05). Fifty-five percent of the hospitals were academic, whereas 45% were nonacademic. Academic status was not related to the type of consent in either window.Significant variability exists in the types of informed consent based on hospital bed size and treatment windows across NYS DOH designated stroke centers.

Introduction: EMS stroke prenotification (S-PN) expedites and increases tPA use. In 1/15, the New York State Dept. of Health (NYS DOH) began tracking S-PN data; however the baseline S-PN frequency and stroke teams’ S-PN experiences and practices in New York City (NYC) and Long Island (LI) had not been established. Hypothesis: The American Heart Association American Stroke Association NYC Stroke Task Force (NYC STF), a panel of stroke clinicians from NYC and LI, sought to assess current regional S-PN experiences. Methods: Online survey by the NYC STF was opened to NYS DOH designated stroke centers in NYC and LI from 12/8/14-1/12/15. Hospitals were instructed to respond based on the previous 12 months, using data or best estimation. Results were analyzed with frequency distributions. Results: Response rate= 75.8% (47/62 hospitals). Respondents: Stroke Coordinators= 66.0%, Stroke Directors= 10.6%, other= 23.4%. Most hospitals received patients from Fire Dept., City of NY (n= 38) and other private/municipal EMS. Many (53.2%) reported receiving S-PN for eligible patients 50% of the time. ED nurses most often received initial S-PN (n= 36), followed by ED clerks (n= 17); 80.4% of hospitals gave stroke triage training to these personnel. Most hospitals (91.5%) used a single-call activation for stroke team/radiology; only 57.5% reported activating it >50% of the time before patient arrival. Contact information for kin/witness (n=37), patient name (n=27) and birthdate (n=25) were most desired to add to S-PN. Frequently perceived barriers: inconsistently receiving S-PN from EMS (n=39), incomplete S-PNs (n=24). Most hospitals (65.8%) perceived positive impact of S-PN; 34.2% perceived no impact/too early to tell. Conclusions: In 2014, stroke teams in NYC and LI perceived wide variations in the rate of S-PN. ED nurses, clerks and EMS personnel are prime recipients for stroke triage training. Hospitals desire contact/identifying information as part of S-PN. More consistent documentation and review of S-PN data is needed to improve its impact on stroke care.