New research by a team at Washington University School of Medicine in St. Louis, indicates that making a simple change to the electronic system used by doctors to order urine tests can cut by nearly half the number of bacterial culture tests ordered without compromising the ability to identify people who need treatment for UTIs. The change encourages doctors to first look for signs of a UTI before testing a patient’s urine for bacteria.
Before ordering a urinalysis to check for bacteria in the urine, infectious disease specialists recommend that physicians look first for signs of bladder infection using a urine dipstick test. This test can detect inflammatory cells in the urine – signs of a problematic UTI that may require treatment with antibiotics. Discovering bacteria growing in the urine without knowing whether the patient has signs and symptoms of infection leaves physicians uncertain of whether the patient will benefit from antibiotic treatment.
The researchers compared all urine culture tests ordered at Barnes-Jewish Hospital in the 15 months before the intervention, staged in April 2016, to the 15 months after. Before the intervention, doctors ordered 15,746 urine cultures, or 38 orders per 1,000 patient-days. After, they ordered 45 percent fewer: 8,823 total, or 21 orders per 1,000 patient-days.
In particular, the number of urine cultures from people with catheters dropped from 7.8 to 1.9 per 1,000 patient-days while the number of catheter-associated UTIs did not change at all. There were 125 diagnosed catheter-associated UTIs in each time period.
Since it costs about $15 to perform a urine culture, the intervention saved approximately $104,000 in laboratory costs alone over the 15-month period.