Reducing Overtreatment of Urinalysis in Obstetric Triage Patients

Abstract

Overtreatment of asymptomatic bacteriuria (ASB) is a major issue that has been coming to the forefront in recent decades. Studies have shown that it can lead to adverse side effects, extra costs and antimicrobial resistance. The purpose of this study was to determine the number of patients presenting to obstetric triage who were over treated for a urinalysis (UA), and if an educational intervention could reduce the incidence of overtreatment for suspected ASB. This was a retrospective chart review analyzing UA results and outcomes of OB triage patients that came through labor and delivery before and after an educational intervention.Two time periods were identified: Cohort 1 (Pre-intervention) included patients from March- May of 2017. Cohort 2 (Post-intervention) included patients from March – May 2018.These time periods were chosen to have similar training levels on labor and delivery triage. Based on UA criteria it was then determined if subjects were treated appropriately. 1312 charts were reviewed; 601 in Cohort 1 (pre-intervention) and 711 in Cohort 2 (post intervention). There was a significant reduction in subjects who were over-treated for UA following the intervention. In our study, a resident to resident didactic session appears to have reduced the incidence of overtreatment of bacteriuria. This type of intervention could lead to more cost-efficient care and reduce complications for individual pregnant patients.