Hostname: page-component-6dbcb7884d-4vmf6 Total loading time: 0 Render date: 2025-02-13T22:30:22.226Z Has data issue: false hasContentIssue false
  • English
  • Français

Using clinical decision support to improve urine culture diagnostic stewardship, antimicrobial stewardship, and financial cost: A multicenter experience

Published online by Cambridge University Press:  05 March 2020

Kaitlin J. Watson ,
Barbara Trautner ,
Hannah Russo ,
Kady Phe ,
Todd Lasco ,
Takei Pipkins ,
Bradley Lembcke  and
Mayar Al Mohajer
Kaitlin J. Watson
Affiliation:
School of Public Health Professions, Baylor College of Medicine, Houston, Texas, USA
Barbara Trautner
Affiliation:
Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA Department of Surgery, Baylor College of Medicine, Houston, Texas, USA
Hannah Russo
Affiliation:
Catholic Health Initiative, Baylor St Luke’s Medical Center, Houston, Texas, USA
Kady Phe
Affiliation:
Catholic Health Initiative, Baylor St Luke’s Medical Center, Houston, Texas, USA
Todd Lasco
Affiliation:
Catholic Health Initiative, Baylor St Luke’s Medical Center, Houston, Texas, USA Department of Pathology, Baylor College of Medicine, Houston, Texas, USA
Takei Pipkins
Affiliation:
Catholic Health Initiative, Baylor St Luke’s Medical Center, Houston, Texas, USA
Bradley Lembcke
Affiliation:
Catholic Health Initiative, Texas Division, Houston, Texas, USA
Mayar Al Mohajer*
Affiliation:
Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
*
Author for correspondence: Mayar Al Mohajer, MD, E-mail: mohajer@bcm.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

Despite evidence to the contrary, many practitioners continue to inappropriately screen for and treat bacteria in the urine of clinically asymptomatic patients. The purpose of this study was to evaluate the impact of a new order set on the number of urine culture performed, antibiotic days of therapy (DOT), catheter-associated urinary tract infections (CAUTI), and associated financial impact.

Design:

A quasi-experimental before-and-after intervention.

Setting:

We conducted this study at 5 Catholic Health Initiative (CHI) hospitals in Texas that use the same electronic health record (EHR) system.

Patients:

The study populations included adult patients who had urine culture performed from June 2017 to June 2019.

Intervention:

The intervention (implemented June 25, 2018) was the addition of a new order set in the electronic health record that required practitioners to choose an indication for the type of urine study. The primary outcome was number of urine cultures performed adjusted for the number of total patient days.

Results:

Following implementation of the new order set, the number of urine cultures performed among the 5 sites decreased from 1,175.8 tests per 10,000 patient days before the intervention to 701.4 after the intervention (40.4% reduction; P < .01). Antibiotic DOT for patients with a urinary tract infection indication decreased from 102.5 to 86.9 per 1,000 patient days (15.2% reduction; P < .01). The CAUTI standardized infection ratio was 1.0 before the intervention and 0.8 after the intervention (P = .23). The estimated yearly savings following the intervention was US$535,181.

Conclusions:

The addition of a new order set resulted in decreases in the number of urine cultures performed and the antibiotic DOT, as well as substantial financial savings.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 5 , May 2020 , pp. 564 - 570
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: Preliminary data were presented as an abstract at the European Congress for Clinical Microbiology and Infectious Diseases (ECCMID) 2019 on April 14, 2019, in Amsterdam, Netherlands.

References

Marschall, J, Piccirillo, ML, Foxman, B, Zhang, L, Warren, DK, Henderson, JP. Patient characteristics but not virulence factors discriminate between asymptomatic and symptomatic E. coli bacteriuria in the hospital. BMC Infect Dis 2013;13:213.CrossRefGoogle Scholar
Trautner, BW. Asymptomatic bacteriuria: when the treatment is worse than the disease. Nat Rev Urol 2012;9:85–93.CrossRefGoogle Scholar
Nicolle, LE, Gupta, K, Bradley, SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of America. Clin Infect Dis 2019;68:1611–1615.CrossRefGoogle ScholarPubMed
Yin, P, Kiss, A, Leis, JA. Urinalysis orders among patients admitted to the general medicine service. JAMA Intern Med 2015;175:1711.CrossRefGoogle ScholarPubMed
Loeb, M, Brazil, K, Lohfeld, L, et al. Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial. BMJ 2005;331:669.CrossRefGoogle ScholarPubMed
Trautner, BW, Grigoryan, L, Petersen, NJ, et al. Effectiveness of an antimicrobial stewardship approach for urinary catheter–associated asymptomatic bacteriuria. JAMA Intern Med 2015;175:1120.CrossRefGoogle ScholarPubMed
Hecker, MT, Fox, CJ, Son, AH, et al. Effect of a stewardship intervention on adherence to uncomplicated cystitis and pyelonephritis guidelines in an emergency department setting. PLoS One 2014;9(2):e87899.CrossRefGoogle Scholar
Keller, SC, Feldman, L, Smith, J, Pahwa, A, Cosgrove, SE, Chida, N. The use of clinical decision support in reducing diagnosis of and treatment of asymptomatic bacteriuria. J Hosp Med 2018;13:392–395.Google ScholarPubMed
Trautner, BW, Kelly, PA, Petersen, N, et al. A hospital-site controlled intervention using audit and feedback to implement guidelines concerning inappropriate treatment of catheter-associated asymptomatic bacteriuria. Implement Sci 2011;6:41.CrossRefGoogle ScholarPubMed
Naik, AD, Skelton, F, Amspoker, AB, Glasgow, RA, Trautner, BW. A fast and frugal algorithm to strengthen diagnosis and treatment decisions for catheter-associated bacteriuria. De Socio GV, ed. PLoS One 2017;12(3):e0174415.CrossRefGoogle ScholarPubMed
Cunha, BA. Principles of antibiotic formulary selection for P&T committees. P AND T 2003;28:396–396.Google Scholar
Hollenbeak, CS, Schilling, AL. The attributable cost of catheter-associated urinary tract infections in the United States: a systematic review. Am J Infect Control 2018;46:751–757.CrossRefGoogle ScholarPubMed
Sullivan, KV, Morgan, DJ, Leekha, S. Use of diagnostic stewardship practices to improve urine culturing among SHEA Research Network hospitals. Infect Control Hosp Epidemiol 2019;40:228–231.CrossRefGoogle ScholarPubMed