EHR Integrated Urine Culture Algorithm Is an Effective Diagnostic Stewardship Strategy

Abstract

<h3>Background</h3> Diagnostic stewardship can be a high-impact, low-effort strategy to optimize clinical outcomes through implementation of evidence-based guidelines and electronic health record (EHR) decision support. Published practice guidelines indicate appropriate indications for diagnostic urine cultures for evaluation of urinary tract infection. <h3>Methods</h3> A multidisciplinary team reviewed current evidence-based practice guidelines and developed a urine culture algorithm including a list of approved indications and updated urinalysis (UA) reflex to culture criteria. The protocol was implemented into the electronic health record, including requirements for the providers to list an approved indication for urine culture, and updated UA reflex criteria. Number of urine cultures tested, number of catheter-associated urinary tract infection (CAUTI) events, and CAUTI rate was assessed pre and post protocol implementation. <h3>Results</h3> Urine cultures, CAUTIs, and CAUTI rates were reviewed for one year prior to implementation and one year after implementation, 03/2019-02/2020 and 03/2020-02/2021. Comparing the baseline year of data to the year after implementation revealed that the implementation of the urine culture algorithm resulted in a 23.5% reduction in the amount of urine culture tests completed (p<.001). A 15.9% CAUTI reduction and a 23.3%5 CAUTI rate reduction were also obtained. <h3>Conclusions</h3> Diagnostic stewardship can be an important part of an infection prevention program. The implementation of an evidence-based urine culture algorithm resulted in a statistically significant reduction in urine culture tests. A reduction in CAUTI events and CAUTI rates were also obtained. Integrating the algorithm into the electronic medical record and obtaining input from a multidisciplinary team were key components to achieving successful implementation.