Using clinical decision support to improve urine testing and antibiotic utilization.



Urine cultures collected from catheterized patients have a high likelihood of false-positive results due to colonization. We examined the impact of a clinical decision support (CDS) tool that includes catheter information on test utilization and patient-level outcomes.


This before-and-after intervention study was conducted at 3 hospitals in North Carolina. In March 2021, a CDS tool was incorporated into urine-culture order entry in the electronic health record, providing education about indications for culture and suggesting catheter removal or exchange prior to specimen collection for catheters present >7 days. We used an interrupted time-series analysis with Poisson regression to evaluate the impact of CDS implementation on utilization of urinalyses and urine cultures, antibiotic use, and other outcomes during the pre- and postintervention periods.


The CDS tool was prompted in 38,361 instances of urine cultures ordered in all patients, including 2,133 catheterized patients during the postintervention study period. There was significant decrease in urine culture orders (1.4% decrease per month; P < .001) and antibiotic use for UTI indications (2.3% decrease per month; P = .006), but there was no significant decline in CAUTI rates in the postintervention period. Clinicians opted for urinary catheter removal in 183 (8.5%) instances. Evaluation of the safety reporting system revealed no apparent increase in safety events related to catheter removal or reinsertion.


CDS tools can aid in optimizing urine culture collection practices and can serve as a reminder for removal or exchange of long-term indwelling urinary catheters at the time of urine-culture collection.






Published Version (Please cite this version)


Publication Info

Yarrington, Michael E, Staci S Reynolds, Tray Dunkerson, Fabienne McClellan, Christopher R Polage, Rebekah W Moehring, Becky A Smith, Jessica L Seidelman, et al. (2023). Using clinical decision support to improve urine testing and antibiotic utilization. Infection control and hospital epidemiology, 68. pp. 1–5. 10.1017/ice.2023.30 Retrieved from

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Michael Yarrington

Assistant Professor of Medicine

Staci Reynolds

Clinical Professor in the School of Nursing

Dr. Staci Reynolds joined Duke in January 2016, with a joint position between Duke University School of Nursing and Duke University Hospital (DUH).  At DUSON, Dr. Reynolds teaches in the ABSN Program (neuroscience nursing) and DNP program (healthcare quality improvement methods).  Clinically, she served as a neuroscience Clinical Nurse Specialist (CNS) for the inpatient neuro units at DUH from 2016 - 2019 and for the Infection Prevention and Hospital Epidemiology department from 2019 - 2023. Dr. Reynolds coordinated the Duke Advancement of Nursing, Center of Excellence (DANCE) academic-practice partnership from 2016 - 2023, and was the faculty lead for the post-DNP Quality Implementation Scholars Program from 2019 - 2022.  In January 2023, Dr. Reynolds was appointed the Editor-in-Chief of the Journal of Nursing Care Quality.  Before coming to DUSON, she was a neuro critical care nurse and a neuroscience Clinical Nurse Specialist at Indiana University Health Methodist Hospital.

Dr. Reynolds received a baccalaureate degree in nursing science from Indiana University (IU) in Indianapolis, Indiana.  She earned a Master’s degree as a Clinical Nurse Specialist at IU in 2011, and completed her PhD at IU in May 2016.  Dr. Reynolds’ dissertation focused on implementation of clinical practice guidelines, and her current research interests includes evidence-based practice implementation and quality improvement.


Rebekah Moehring

Associate Professor of Medicine

Jessica Seidelman

Associate Professor of Medicine

Sarah Stamps Lewis

Associate Professor of Medicine

Sonali Advani

Associate Professor of Medicine

Dr. Advani is an Associate Professor of Medicine (Tenure Track) at Duke University School of Medicine. She is primarily a physician investigator in the Duke Center for Antimicrobial Stewardship and Infection Prevention. She is currently a Fellow in Implementation Science at HIGH IRI (HIV, Infectious Disease and Global Health Implementation Research) Institute at Washington University, St Louis.

Dr. Advani has over 10-years' experience in healthcare epidemiology research and operations. Her current research focuses on improving the diagnosis of UTIs in older adults, implementation of diagnostic stewardship interventions, and de-prescribing antibiotics for asymptomatic bacteriuria. She was awarded the K12 Urologic Career Development Award, Pepper Center Career Development Award, and SHEA Research Scholar Award to continue her UTI related research. In addition, she is one of the key investigators for CDC Prevention Epicenter Program and CDC SHEPheRD Contract for the Use of Race, Ethnicity, and Social Determinants of Health Data in NHSN Measures to Promote Health Equity.

Dr. Advani currently serves on the SHEA Program Planning Committee, SHEA Research Committee, SHEA Diagnostic Stewardship Task Force,  SHEA Steering Committee for the LEAP Fellowship, and IDSA Antimicrobial Stewardship Workgroup. She is contributing to the upcoming SHEA CAUTI Compendium, SHEA Nursing Home Infection Prevention Guidance, AUGS Bacteriuria Consensus Guidance, and SHEA HAI Research Agenda.

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