Choosing wisely initiative for reducing urine cultures for asymptomatic bacteriuria and catheter-associated asymptomatic bacteriuria in an 11-hospital safety net system

Reducing unnecessary urine culture testing in residents of long term care facilities

“…Decision support systems and requiring the input of clinical indication for each urine culture may have limited impact, possibly because prescribers select UTI for all cases,42 but a US intervention across 11 hospitals and 70 outpatient clinics showed a 20% reduction in urine cultures with this approach 43. Audit and feedback of urine culture ordering or prescriptions of antibiotics commonly used for UTI may also drive reductions and at minimum limit antibiotic duration 444546.…”

“…Decision support systems and requiring the input of clinical indication for each urine culture may have limited impact, possibly because prescribers select UTI for all cases, 42 but a US intervention across 11 hospitals and 70 outpatient clinics showed a 20% reduction in urine cultures with this approach. 43 Audit and feedback of urine culture ordering or prescriptions of antibiotics commonly used for UTI may also drive reductions and at minimum limit antibiotic duration. 44 45 46 Finally, interventions within the laboratory to reject or modify reporting of urinary isolates that are likely to be ASB can markedly improve antibiotic prescribing practices while preserving prescriber autonomy, although these strategies require additional study in long term care settings.…”

Initiative to reduce inappropriate venous thromboembolism prophylaxis in an 11‐hospital safety net system: An electronic health records‐based approach

“…21 However, our recent published successes in reducing overuse in our system shed some insights into implementation. 18,[22][23][24][25] In particular, EHR-based interventions, if developed well and tailored through expert stakeholder input, can bring forth a low-effort, highimpact change suited for large, resource-limited settings. An important concept is that order sets are effective only so much as clinicians use them.…”

Clinical decision support menu for reducing unnecessary urine cultures

“…This type of CDS intervention has been effective in decreasing UCs in limited settings including inpatients with indwelling catheters or within a single outpatient clinic. 7 , 8 To reduce unnecessary UCs in all settings at the Minneapolis Veterans Affairs Health Care System (MVAHCS), clinicians placing UC orders within the electronic medical record (EMR), known as the Computerized Patient Record System (CPRS), were directed to a UC CDS menu, providing clinical guidance and requiring selection of a single indication to place the order.…”