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David K. Warren
An intervention that included the modification of the electronic control system to encourage urine test reflex tests for suspicion of urinary tract infections resulted in a 45% reduction in the number urine cultures ordered in a St. Louis hospital, without any urinary tract infections, Infection control And Hospital epidemiology.
"Excessive testing for urinary tract infections increases health care costs and leads to unnecessary use of antibiotics, resulting in increased resistance to antibiotics" David K. Warren, MD, MPH, a professor of medicine from the division of infectious diseases of the faculty of medicine of the University of Washington and an epidemiologist from a hospital of the Barnes-Jewish Hospital, both located in St. Louis, said in a press release.
"Ordering tests when the patient needs them is a good thing. But ordering tests when it is not indicated wastes resources and can subject patients to unnecessary treatment. "
Warren and his colleagues made two changes to the way the urine tests are done at the Barnes-Jewish Hospital. As explained in the press release, they first sent an email to clinicians to explain the reasons for ordering urine test strip tests to detect signs of diarrhea. urinary tract infection before ordering a bacterial culture. They also changed the electronic control system to make the default test a urine gauge (not a culture), leaving clinicians the ability to order a culture test themselves, even if they wanted it. after opening an extra screen on their computers.
For their study, Warren and his colleagues included adults who had at least one culture of urine during their stay. They compared urine culture rates from January 2015 to April 2016 – before the one – month intervention conducted in April 2016 – at the rates from May 2016 to August 2017, after the first one. intervention.
Warren and colleagues reported that 18,954 patients (median age, 62 years, 52.3% women) received 24,569 orderly urine cultures; 27% of the crops were positive. According to the results, there was a significant decrease in the rate of urine culture during the post-intervention period for any type of sample compared to the pre-intervention period (38.1 per 1,000 days patients vs. 20.9 per 1,000 patient days), net and catheterized (7.8 vs 1.9; P <0.001, all). They also reported that urine culture rates had decreased for all types of samples when an interrupted time series model was used.
"By encouraging clinicians to use reflex urine test, rather than urine cultures for hospitalized patients, we have drastically reduced the number of urine cultures performed at home." these patients, "said Warren Infectious Diseases News. "At the same time, we found no change in the IU rates badociated with the catheter, suggesting that we were not missing from IU."
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Warren added that the study showed the importance of designing computerized physician order entry systems.
"Our study shows that relatively minor modifications to these systems can have a major impact on test practices, which can limit unnecessary testing and potentially unnecessary use of antibiotics," he says. declared. – by Bruce Thiel
Disclosures: The authors do not report any relevant financial information.
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