SHM Converge Scientific Abstract ePoster Gallery-Urine Trouble: Improving Diagnostic Stewardship Through Enhanced Clinical Decision Support

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This project focused on improving diagnostic stewardship around urine testing at UVA Health. Based on institutional and IDSA guidelines, the team noted that urine tests are often ordered without appropriate indications, leading to unnecessary antibiotics, increased resistance, longer hospital stays, and more Clostridioides difficile infections. Diagnostic stewardship was also identified as a contributor in 57% of CAUTI events at the institution in FY24.<br /><br />A 12-month chart review of 169 patients on three inpatient medicine units found that appropriate reasons for urine testing were documented only 47% of the time. Among patients who received inappropriate urine testing, 25% were treated with antibiotics. Common inappropriate reasons included isolated fever without urinary symptoms, altered mental status with a more likely alternate cause, and evaluation of non-infectious problems such as acute kidney injury.<br /><br />To address this, the team redesigned clinical decision support (CDS) to reduce common sources of inappropriate testing. After implementation, they observed an increase in urinalysis orders with reflex microscopy, but no increase in SIRS alerts. Follow-up chart audits of 28 patients showed improvement in appropriate ordering to 60%, especially by reducing urine testing for AKI workups. However, some inappropriate orders persisted, often due to urine testing ordered without focal urinary symptoms.<br /><br />Overall, the project suggests that inappropriate urine testing remains common and contributes to unnecessary antibiotic use and CAUTI events, but enhanced CDS can improve diagnostic stewardship. Further intervention is still needed to reduce guideline-discordant urine testing.

Asset Subtitle

Amber Inofuentes

Meta Tag

Author List Amber Inofuentes, Greg Madden, Lain William, Patrick Jackson, Rebecca Corey

Category Innovations

Concept Diagnostic Stewardship

Concept Urine Testing

Concept Urinalysis

Concept Antibiotic Use

Concept Antibiotic Resistance

Distinguished Non-Finalist

Presenter Organization UVA Health

Presenting Author Amber Inofuentes

Track Quality Improvement

Keywords

diagnostic stewardship

urine testing

urinalysis

clinical decision support

inappropriate ordering

antibiotic overuse

CAUTI

hospital-acquired infection

guideline adherence

UVA Health

Diagnostic Stewardship

Urine Testing

Urinalysis

Antibiotic Use

Antibiotic Resistance