ArticleBMJ quality & safety2018
Impact of order set design on urine culturing practices at an academic medical centre emergency department.
Article in BMJ quality & safety, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 3 of them syntheses that pooled it.
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Who cites it
19 citing papers in PubMed, 3 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- The role of information systems in emergency department decision-making-a literature review.Journal of the American Medical Informatics Association : JAMIA · 2024Pooled it
- Effectiveness of non-interruptive nudge interventions in electronic health records to improve the delivery of care in hospitals: a systematic review.Journal of the American Medical Informatics Association : JAMIA · 2023Pooled it
- The effectiveness of behavioral economics-informed interventions on physician behavioral change: A systematic literature review.PloS one · 2020Pooled it
- Development and validation of an antimicrobial stewardship clinical decision-support tool to improve the management of urinary tract infections versus asymptomatic bacteriuria in hospitalized patients.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Article
- Pyuria in hospitalized general medical patients without urinary tract infection.F1000Research · 2024Article
- A decade of clinical microbiology: top 10 advances in 10 years: what every infection preventionist and antimicrobial steward should know.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2024Review
- Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 Update.Infection control and hospital epidemiology · 2023Article
- An Electronic Health Record Intervention to Limit Viral Testing of Cerebrospinal Fluid.The Neurohospitalist · 2023Article
- Leveraging diagnostic stewardship within antimicrobial stewardship programmes.Drugs in context · 2023Review
- Can Electronic Clinical Decision Support Systems Improve the Diagnosis of Urinary Tract Infections? A Systematic Review and Meta-Analysis.Open forum infectious diseases · 2023Article
- Impact of computerised provider order entry on the quality and quantity of clinical information included with investigation requests: an interrupted time series analysis.BMJ open quality · 2023Article
- Why Are We Frequently Ordering Urinalyses in Patients without Symptoms of Urinary Tract Infections in the Emergency Department?International journal of environmental research and public health · 2022Article
- Evaluating the Impact of a Urinalysis to Reflex Culture Process Change in the Emergency Department at a Veterans Affairs Hospital.Federal practitioner : for the health care professionals of the VA, DoD, and PHS · 2022Article
- Behavioral Economics and Ambulatory Antibiotic Stewardship: A Narrative Review.Clinical therapeutics · 2021Review
- Deconstructing the urinalysis: A novel approach to diagnostic and antimicrobial stewardship.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2021Article
- Sustained decrease in urine culture utilization after implementing a reflex urine culture intervention: A multicenter quasi-experimental study.Infection control and hospital epidemiology · 2020Article
- When order sets do not align with clinician workflow: assessing practice patterns in the electronic health record.BMJ quality & safety · 2019Article
- Advances and Challenges in the Diagnosis and Treatment of Urinary Tract Infections: the Need for Diagnostic Stewardship.Current infectious disease reports · 2019Review
- Effect of changing urine testing orderables and clinician order sets on inpatient urine culture testing: Analysis from a large academic medical center.Infection control and hospital epidemiology · 2019Article
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundUrinalysis and urine culture are commonly ordered tests in the emergency department (ED). We evaluated the impact of removal of order sets from the 'frequently ordered test' in the computerised physician order entry system (CPOE) on urine testing practices.
methodsWe conducted a before (1 September to 20 October 2015) and after (21 October to 30 November 2015) study of ED patients. The intervention consisted of retaining 'urinalysis with reflex to microscopy' as the only urine test in a highly accessible list of frequently ordered tests in the CPOE system. All other urine tests required use of additional order screens via additional mouse clicks. The frequency of urine testing before and after the intervention was compared, adjusting for temporal trends.
resultsDuring the study period, 6499 (28.2%) of 22 948 ED patients had ≥1 urine test ordered. Urine testing rates for all ED patients decreased in the post intervention period for urinalysis (291.5 pre intervention vs 278.4 per 1000 ED visits post intervention, P=0.03), urine microscopy (196.5vs179.5, P=0.001) and urine culture (54.3vs29.7, P<0.001). When adjusted for temporal trends, the daily culture rate per 1000 ED visits decreased by 46.6% (-46.6%, 95% CI -66.2% to -15.6%), but urinalysis (0.4%, 95% CI -30.1 to 44.4%), microscopy (-6.5%, 95% CI -36.0% to 36.6%) and catheterised urine culture rates (17.9%, 95% CI -16.9 to 67.4) were unchanged.
conclusionsA 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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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.