SHM Converge Scientific Abstract ePoster Gallery-Limiting Waste: Reducing Urine Culture Testing in Inpatients

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A student-led quality improvement project at Mount Sinai Hospital aimed to reduce unnecessary urine culture testing on general medicine inpatient floors by 20% over one year (July 2022 to June 2023). The project was motivated by evidence that many urine cultures are ordered without appropriate clinical indication, which can lead to overdiagnosis of asymptomatic bacteriuria, unnecessary antibiotic use, side effects, longer hospital stays, higher costs, and reduced reimbursement.<br /><br />Using the Model for Improvement, the team first gathered baseline information through chart review, staff surveys, and faculty interviews to identify causes of inappropriate testing. Key contributors included easy ordering through the EMR, limited awareness of the institutional algorithm, fear of missing infection or sepsis, nursing reluctance to question orders, and workflow barriers such as rushed admissions and varying provider training.<br /><br />The interventions included:  <br />1. Modifying the EMR urine culture order with prompts and instructions.  <br />2. Educating frontline providers about the harms of inappropriate testing and promoting use of the clinical algorithm.  <br />3. Encouraging nurses to question urine culture orders that did not meet institutional criteria through an existing escalation process.<br /><br />Results showed a reduction in urine cultures from an average of 30 per month before the intervention to 25 per month after, a 17% decrease over 12 months. A shift in the run chart was observed after the second PDSA cycle, suggesting the interventions had an effect even though the original goal was not fully met.<br /><br />Strengths of the project included its alignment with hospital goals, minimal resource needs, and potential sustainability. Challenges included COVID-19 disruptions, leadership turnover, delays in EMR changes, and low attendance at some educational sessions. The project concluded that understanding local systems and sustaining iterative improvement are essential for reducing low-value urine culture testing.

Asset Subtitle

Sungjae Park

Meta Tag

Author List Brian Y. Soong, Daniel Liu, Evelyn Zhang, Reem Aoun, Sungjae Park, Vinh-Tung Nguyen

Category Innovations

Concept Urine Culture Testing

Concept Asymptomatic Bacteriuria

Concept Quality Improvement

Concept Unnecessary Testing

Concept Unnecessary Treatment

Distinguished Non-Finalist

Presenter Organization Icahn School of Medicine

Presenting Author Sungjae Park

Track Quality Improvement

Keywords

quality improvement

urine culture

inappropriate testing

general medicine

hospital inpatient

EMR modification

clinical algorithm

asymptomatic bacteriuria

antibiotic stewardship

PDSA cycle

Urine Culture Testing

Asymptomatic Bacteriuria

Quality Improvement

Unnecessary Testing

Unnecessary Treatment