Using clinical decision support to improve urine testing and antibiotic utilization.
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2023-03
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Abstract
Objective
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.Methods
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.Results
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.Conclusion
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.Type
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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 https://hdl.handle.net/10161/28301.
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Scholars@Duke
Michael Yarrington
Staci Reynolds
Dr. Staci Reynolds is a Clinical Professor at Duke University School of Nursing (DUSON). At DUSON, Dr. Reynolds primarily teaches in the DNP program. Previously, she clinically served as a Clinical Nurse Specialist (CNS) at Duke University Hospital within the neuroscience inpatient units and Infection Prevention and Hospital Epidemiology department. 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 neurocritical care nurse and a neuroscience CNS at Indiana University Health Methodist Hospital.
Dr. Reynolds received a baccalaureate degree in nursing science from Indiana University (IU) School of Nursing 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’ current scholarship interests include evidence-based practice implementation and evaluation, and she is an expert in quality improvement.
Rebekah Moehring
Jessica Seidelman
Sarah Stamps Lewis
Sonali Advani
Dr. Advani is an Adjunct Associate Professor of Medicine at Duke University School of Medicine. In July 2024, she joined GSK/ViiV Healthcare as a scientific leadership physician with cross functional experience across global medical affairs as well as Research & Development in HIV therapeutics and vaccines.
Prior to this, she served as a physician investigator in the Duke Center for Antimicrobial Stewardship and Infection Prevention, a Fellow in Implementation Science at HIGH IRI (HIV, Infectious Disease and Global Health Implementation Research) Institute at Washington University, St Louis and Associate Medical Director of Infection Prevention at Yale New Haven Hospital. Her research focused 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 was 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.
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