Change in Electronic Order Set Linked to Decrease in Urine Cultures Ordered

Urinalysis rates decreased after a change in electronic order sets was made.

NEW ORLEANS — A single change in electronic order sets for urine testing can be linked to a decrease in the number of urine cultures ordered in the emergency department, according to research presented at ID Week 2016.

Satish Munigala, MBBS, MPH, from the department of internal medicine at Washington University in St. Louis, Missouri, and colleagues conducted a retrospective analysis of patients in the emergency department who received either urinalysis with reflex to culture, urinalysis, and/or microscopy, after a change was made in the electronic sets used to order urine testing.

Urinalysis with reflex to culture, which was previously part of a set of commonly ordered tests, was shifted to category-specific order sets for hematology/coagulation/urinalysis and microbiology; urinalysis with reflex to microscopy was kept as a part of the common order set, and urine culture was kept as part of the microbiology order set.

During the study, 28.2% of 22,948 emergency department patients were identified as having had at least 1 urine test ordered (27.8% post-change vs 28.5% pre-change, P =.22). Patients who underwent urine testing post-change were more likely to be admitted to the hospital (45.1% vs 33.6%, P <.001). In the 41 days after the change was made, the number of urine dipstick tests per 1000 patient visits decreased from 284.1 pre-change to 270.4 post-change (P =.022), as did urine microscopy tests (182.8 vs 194.2, P =.03) and urinalysis with reflex to culture (22.5 vs 37.3, P <.001). After adjustments were made for overall temporal trend, Dr Munigala and colleagues found that the daily rate of urine cultures decreased by 40.4% (-40.4%; 95% confidence interval [CI], -62.2% to -6.1%). Urine dipstick and microscopy rates remained unchanged.

“A single change to an electronic order set resulted in a 47% reduction in urine cultures ordered in the emergency department,” Dr Munigala and colleagues concluded.

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Munigala S, Poirier R, Liang S, Wood H, Jackups R Jr, Warren D. Location, location, location: A change in urine testing order sets on culturing practices at an academic medical center emergency department.  Presented at: ID Week 2016; October 26-30, 2016; New Orleans, LA. Abstract 1681.