Support tool reduced urine culture tests by 50%
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Key takeaways:
- Researchers implemented a clinical decision support tool for assessing patients with a urinary catheter.
- The tool was associated with an almost 50% decrease in urine culture testing.
A computerized clinical decision support tool implemented as a diagnostic stewardship intervention led to an approximate 50% decrease in urine culture testing for patients with a urinary catheter, researchers found.
“We used diagnostic stewardship to help guide providers at our hospital to more appropriately order urine cultures from patients with indwelling urinary catheters,” Sarah E. Sansom, DO, MS, assistant professor in the division of infectious diseases at Rush University Medical Center, told Healio.
The computerized tool was implemented in February 2021 to “promote adherence to internal urine culture criteria.”
According to the study, the tool required ordering providers to select an institutionally appropriate indication for the urine culture or obtain infectious diseases specialist approval to order a urine culture from a patient with an indwelling urinary catheter.
Sansom and colleagues explained that “institutionally appropriate criteria” for collection of a urine culture from a patient aged 18 years and older, on hospital day 3 or later, with an indwelling urinary catheter or within 24 hours after urinary catheter discontinuation included neutropenia, kidney transplant, urologic surgery within the prior 30 days or radiologic evidence of urinary tract obstruction.
“This type of diagnostic stewardship intervention has been shown to be safe and effective when evaluating patients as a group, but we needed more information on the individual patient level regarding benefits and harms,” Sansom said.
To assess the impact of the tool, Sansom and colleagues conducted a retrospective study divided into the baseline period (April 2018 to January 2021) and the intervention period (February 2021 to July 2023) during which they analyzed patient-level outcomes and adverse events. The primary outcome was a change in the facility-wide catheter-associated urinary tract infection (CAUTI) rate per 1,000 catheter-days between the two study periods.
Overall, the adjusted CAUTI rate decreased from 1.203 to 0.75 per 1,000 catheter-days (P = .52) after the intervention was implemented. There was a total of 598 patients triggering decision support, for which 284 (47.5%) urine cultures were collected that were documented to meet institutional appropriateness criteria.
An infection prevention team assessed provider selected indications and identified an average of 3.75 false indications — such as a provider-selected neutropenia but the patient not being neutropenic — per month.
“A computerized diagnostic stewardship intervention using clinical decision support was safe and effective as part of a multimodal program to reduce unnecessary urine cultures in patients with indwelling urinary catheters,” Sansom concluded. “Our study adds further evidence supporting the utility and safety of diagnostic stewardship to improve patient care.”
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