Cost analysis of urine testing for hospitalized patients in the emergency department.

Introduction: Urinary tract infections (UTIs) are commonly diagnosed in the emergency department (ED). However, an accurate diagnosis requires an appropriate clinical presentation. The objective of this retrospective review of patients admitted to the hospital via the ED was to determine the extent of urinary testing for infection despite no appropriate medical criteria and the associated economic costs. Methods: Adult patients admitted to an academic medical center via the ED in two 1-week periods were reviewed. The medical records were manually reviewed to determine whether the urine was tested for infection and whether this was medically necessary based on generally accepted clinical criteria. The economic cost of the unnecessary testing was determined based on direct laboratory processing costs, staffing costs associated with sample acquisition and processing, and antimicrobials prescribed. Results: There were 401 admissions to the hospital via the ED in the two 1-week timeframes, and 212 (52.87%) had urinalyses on admission. Among them, 133 (62.74%) had no medical necessity for the testing. The total annual cost was extrapolated to a direct cost of $8,490.68 and a total cost of $49,701.01. Conclusions: These results demonstrate the projected annual cost of inappropriate urine testing in patients admitted through the ED. Data such as these may be of value to hospital systems in the design or creation of order sets to focus on appropriate testing. These data would also be helpful for diagnostic stewardship programs to help rein in the ever-increasing cost of healthcare.