External validation of an ED protocol for reflex urine culture cancelation

Hertz, Julian T.; Lescallette, Richard D.; Barrett, Tyler W.; Ward, Michael J.; Self, Wesley H.

doi:10.1016/j.ajem.2015.09.026

Cited by 16 publications

(9 citation statements)

References 3 publications

(6 reference statements)

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“…Results of our study complement recent intervention studies to improve urine culture practices, such as two-step urine culture ordering (4), reflex urine culture cancellation protocol (1, 9), pharmacist driven antimicrobial stewardship efforts (5), distribution of a pocket card to clinicians outlining a diagnostic algorithm for UTI diagnosis with case-based audit and feedback (2) and suppression of urine culture results from non-catheterized inpatients (16).…”

Section: Discussionsupporting

confidence: 65%

“…Jones and colleagues demonstrated that a reflex urine culture cancellation protocol in the ED, based on low-risk findings for infection on urinalysis, would have eliminated 39% of unnecessary cultures (1). Although this reflex urine culture cancellation protocol was externally validated by Hertz et al (9), these were mainly derivative studies using retrospective data and were not prospectively implemented. While stewardship efforts (5) reduce unnecessary antibiotic prescriptions and the associated costs, they are time-intensive interventions and require constant monitoring.…”

Section: Discussionmentioning

confidence: 99%

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Impact of order set design on urine culturing practices at an academic medical centre emergency department

et al. 2018

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A simple intervention of retaining only 'urinalysis with reflex to microscopy' and removing all other urine tests from the 'frequently ordered' window of the ED electronic order set decreased urine cultures ordered by 46.6% after accounting for temporal trends. Given the injudicious use of antimicrobial therapy for asymptomatic bacteriuria, findings from our study suggest that proper design of electronic order sets plays a vital role in reducing excessive ordering of urine cultures.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Impact of order set design on urine culturing practices at an academic medical centre emergency department

et al. 2018

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“…Recently, a reflex urine culture cancellation protocol where UCs were automatically cancelled if the urinalysis was negative was proposed and externally validated. 9 17 In an observational study, this protocol was predicted to reduce processed UCs by 34.6%–39.1% with only a 1.8%–2.3% false omission rate, similar to the impact of our intervention. In a second external validation, the false omission rate was higher at 4.7%.…”

Section: Discussionsupporting

confidence: 55%

Impact of two-step urine culture ordering in the emergency department: a time series analysis

et al. 2017

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BackgroundDespite evidence against the use of antimicrobials for asymptomatic bacteriuria (ASB), they are frequently prescribed leading to unnecessary adverse events. Prior studies have shown that reducing unnecessary urine cultures (UCs) results in decreased antimicrobial utilisation for ASB. Emergency departments (EDs) submit the largest volume of UCs, yet efforts to limit overordering in this patient setting have had limited success.MethodsA new two-step model of care for urine collection, using a novel UC collection container, was implemented in the ED of a large community hospital. The collection system contains a preservative allowing UCs to be held at room temperature for up to 48 hours before processing. UCs were collected by front-line staff, but only processed in the microbiology lab if requested by ED physicians after clinical assessment.ResultsFollowing implementation there was a decrease in the percentage of weekly ED visits associated with a processed UC (5.97% vs 4.68%, p<0.001), a decrease in the percentage of monthly ED visits requiring a callback for positive urine culture (1.84% to 1.12%, p<0.001) and a decrease in antimicrobial prescriptions for urinary indication among admitted patients (20.6% to 10.9%, p<0.01). There was a false omission rate of 1.35% (95% CI 0.7% to 2.2%), yet no identified cases of untreated urinary tract infection (UTI), or significant change in repeat ED visits or ED length of stay.ConclusionsChanging to two-step urine culture ordering in the ED resulted in a decrease in UCs processed, callbacks for positive results and antimicrobial use without evidence of untreated UTIs. This model of care has strong potential to improve the use of hospital resources while minimising detection and inappropriate treatment of ASB.

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“…developed a protocol, which entailed reflex urine culture cancellation on the basis of low‐risk findings for infection on urinalysis, with a reduction in performance of cultures by 39.1%, with 1.8% of those cultures identified to be suitable for cancellation, subsequently being positive for an organism . Validation studies of this protocol have identified a 34.6% absolute reduction in number of urine cultures completed, with 2.3% of cultures suitable for cancellation in males and 6.9% in females being positive for an organism …”

Section: Clinical Assessmentmentioning

confidence: 99%

“…37 Validation studies of this protocol have identified a 34.6% absolute reduction in number of urine cultures completed, with 2.3% of cultures suitable for cancellation in males and 6.9% in females being positive for an organism. 38…”

Section: Urine Culturementioning

confidence: 99%

Diagnosis of urinary tract infection in older persons in the emergency department: To pee or not to pee, that is the question

Burkett

Carpenter

Arendts

et al. 2019

Emerg Medicine Australasia

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External validation of an ED protocol for reflex urine culture cancelation

Cited by 16 publications

References 3 publications

Impact of order set design on urine culturing practices at an academic medical centre emergency department

Impact of order set design on urine culturing practices at an academic medical centre emergency department

Impact of two-step urine culture ordering in the emergency department: a time series analysis

Diagnosis of urinary tract infection in older persons in the emergency department: To pee or not to pee, that is the question

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