A simple change to how physicians order urine tests can reduce unnecessary urinary tract infection (UTI) tests by nearly half without compromising the identification of patients requiring treatment, according to research by a team at Washington University School of Medicine in St. Louis.
The study, published in Infection Control and Hospital Epidemiology, measured the effectiveness of changing the electronic ordering system used by physicians. The first option presented in the system for ordering urine tests was culture test alone. Researchers changed the default to urine dipstick test followed by a bacterial culture test. Clinicians could still order a culture test alone but were required to open an additional screen.
The rationale behind this change is that it encourages physicians to check for signs of a UTI before testing urine for bacteria, thus reducing over-testing, unnecessary prescribing and use of antibiotics and cost.
Researchers compared all urine culture tests ordered at Barnes-Jewish Hospital in the 15 months prior to the intervention to the 15 months after. Before the intervention, physicians ordered nearly 16,000 urine cultures. After the intervention, they ordered about 8,800 cultures — about 45% fewer. There were 125 diagnosed catheter-associated UTIs in each time period.
"Ordering tests when the patient needs them is a good thing," said senior author and infectious diseases specialist David Warren, MD, a professor of medicine, in a news release. "But ordering tests when it's not indicated wastes resources and can subject patients to unnecessary treatment. We were able to reduce the number of tests ordered substantially without diminishing the quality of care at all."