Highlights
To wisely choose the initiative to reduce urine cultures for asymptomatic bacteriuria and catheter-associated asymptomatic bacteriuria in an 11-hospital safety net system
Summary
Background
Treatment of asymptomatic bacteriuria (ASB) is common.Overtreatment of ASB leads to harm, including adverse effects of antibiotics, antibiotic resistance, and longer length of stay.
Methods
This quality improvement initiative focused on inappropriate urine cultures (UC) in 11 hospitals and 70 outpatient clinics in a safety net setting. We created a mandatory notice for appropriate indications for UC orders and a best practice notice (BPA) for UC in patients with urinary catheters.
Urine culture (UC) order was compared before the intervention (June 2020-October 2021) with post-intervention (December 2021-August 2022). Variation in hospitals and clinics was evaluated, as well as BPA responses by type of physician and specialty.
Results
Inpatient urine cultures (UC) decreased by 20.9% (p <0.001), and outpatient UC did not change (2.6% increase, not significant).UC in hospitalized patients with urinary catheter decreased by 21.6% (p <0.001).
Time trends were also assessed. There was a great deal of variation between hospitals and clinics. Low rates of BPA acceptance were observed in internal medicine and family medicine physicians. Attendees showed a high acceptance of BPA compared to other clinicians.
Conclusions
This initiative successfully reduced UCs in a large safety net system. More studies are needed to assess variation between hospitals and clinics, as well as between types of doctors and specialties.
Comments
The initiative provides a model for resource-limited institutions to decrease overdiagnosis and overtreatment of asymptomatic bacterial infections.
Physicians in the largest safety net hospital system in the United States used two interventions focused on electronic health records (EHR) to significantly reduce inadequate urine cultures among hospitalized patients.The findings of their study, published in the American Journal of Infection Control (AJIC), suggest that low-resource approaches could help reduce overdiagnosis and overtreatment of asymptomatic bacteriuria.
«This quality improvement initiative revealed that low-effort EHR interventions can successfully reduce unnecessary urine culture orders to create better and more efficient care, particularly for vulnerable patient populations,» said Mona Krouss, MD, AVP,
Source — https://www.intramed.net/103777