Introduction: Urinary tract infections currently comprise about one-third of healthcare-associated infections. Current literature found that more than one-quarter of patient receiving antibiotics for urinary tract infection had no specific symptoms, and 60% of patients had urinalyses performed without a specified indication. Frequently, when patients present to the emergency department, urine cultures are ordered which can lead to treatment of asymptomatic bacteriuria. This objective of this research was to examine the effect of implementing a requirement for indications when ordering urinalysis with reflex to culture in the emergency department, with the aim of assessing whether this intervention decreased the rates of test ordering.
Methods: The first intervention of this study enacted in March 2019 provided a passive alert within the electronic medical record notifying providers of when treatment for bacteriuria is indicated when ordering urinalysis with reflex to culture. The second intervention of this study enacted in March 2020 required that prescribers select an indication when ordering urinalysis with reflex culture. This study analyzed data for urinalyses, urine cultures, and urinalyses with reflex to culture collected over a three-month period to determine how the intervention affected the ratio of urine cultures originating from urinalysis with reflex to culture.
Results: The findings of this study indicated that the intervention of requiring indication for ordering did not decrease the ratio of urine cultures originating from urinalysis with reflex to culture. The absence of a discernible reduction in test ordering highlights the need for additional research and exploration. Possible explanations may include physician awareness, knowledge, and adherence to the policy, as well as the complexity and nuances associated with urinalysis interpretation. Further investigation and stakeholder engagement are warranted to ascertain the factors contributing to this outcome and identify potential avenues for improvement in test utilization.
Conclusions: Requiring indication when ordering laboratory testing for urinalysis to culture did not decrease the ratio of urine cultures originating from urinalysis with reflex to culture.
