Using clinical decision support to improve urine testing and antibiotic utilization
OBJECTIVE: Urine cultures collected from catheterized patients have a high likelihood of false-positive results due to colonization. We examined the impact of a clinical decision support (CDS) tool that includes catheter information on test utilization and patient-level outcomes.
METHODS: This before-and-after intervention study was conducted at 3 hospitals in North Carolina. In March 2021, a CDS tool was incorporated into urine-culture order entry in the electronic health record, providing education about indications for culture and suggesting catheter removal or exchange prior to specimen collection for catheters present >7 days. We used an interrupted time-series analysis with Poisson regression to evaluate the impact of CDS implementation on utilization of urinalyses and urine cultures, antibiotic use, and other outcomes during the pre- and postintervention periods.
RESULTS: The CDS tool was prompted in 38,361 instances of urine cultures ordered in all patients, including 2,133 catheterized patients during the postintervention study period. There was significant decrease in urine culture orders (1.4% decrease per month; P < .001) and antibiotic use for UTI indications (2.3% decrease per month; P = .006), but there was no significant decline in CAUTI rates in the postintervention period. Clinicians opted for urinary catheter removal in 183 (8.5%) instances. Evaluation of the safety reporting system revealed no apparent increase in safety events related to catheter removal or reinsertion.
CONCLUSION: CDS tools can aid in optimizing urine culture collection practices and can serve as a reminder for removal or exchange of long-term indwelling urinary catheters at the time of urine-culture collection.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:44 |
|---|---|
| Enthalten in: |
Infection control and hospital epidemiology - 44(2023), 10 vom: 22. Okt., Seite 1582-1586 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Yarrington, Michael E [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
|---|
| Anmerkungen: |
Date Completed 25.10.2023 Date Revised 25.10.2023 published: Print-Electronic Citation Status MEDLINE |
|---|
| doi: |
10.1017/ice.2023.30 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM354928066 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM354928066 | ||
| 003 | DE-627 | ||
| 005 | 20231226063257.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1017/ice.2023.30 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1183.xml |
| 035 | |a (DE-627)NLM354928066 | ||
| 035 | |a (NLM)36987849 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Yarrington, Michael E |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Using clinical decision support to improve urine testing and antibiotic utilization |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 25.10.2023 | ||
| 500 | |a Date Revised 25.10.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a OBJECTIVE: Urine cultures collected from catheterized patients have a high likelihood of false-positive results due to colonization. We examined the impact of a clinical decision support (CDS) tool that includes catheter information on test utilization and patient-level outcomes | ||
| 520 | |a METHODS: This before-and-after intervention study was conducted at 3 hospitals in North Carolina. In March 2021, a CDS tool was incorporated into urine-culture order entry in the electronic health record, providing education about indications for culture and suggesting catheter removal or exchange prior to specimen collection for catheters present >7 days. We used an interrupted time-series analysis with Poisson regression to evaluate the impact of CDS implementation on utilization of urinalyses and urine cultures, antibiotic use, and other outcomes during the pre- and postintervention periods | ||
| 520 | |a RESULTS: The CDS tool was prompted in 38,361 instances of urine cultures ordered in all patients, including 2,133 catheterized patients during the postintervention study period. There was significant decrease in urine culture orders (1.4% decrease per month; P < .001) and antibiotic use for UTI indications (2.3% decrease per month; P = .006), but there was no significant decline in CAUTI rates in the postintervention period. Clinicians opted for urinary catheter removal in 183 (8.5%) instances. Evaluation of the safety reporting system revealed no apparent increase in safety events related to catheter removal or reinsertion | ||
| 520 | |a CONCLUSION: CDS tools can aid in optimizing urine culture collection practices and can serve as a reminder for removal or exchange of long-term indwelling urinary catheters at the time of urine-culture collection | ||
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a Anti-Bacterial Agents |2 NLM | |
| 700 | 1 | |a Reynolds, Staci S |e verfasserin |4 aut | |
| 700 | 1 | |a Dunkerson, Tray |e verfasserin |4 aut | |
| 700 | 1 | |a McClellan, Fabienne |e verfasserin |4 aut | |
| 700 | 1 | |a Polage, Christopher R |e verfasserin |4 aut | |
| 700 | 1 | |a Moehring, Rebekah W |e verfasserin |4 aut | |
| 700 | 1 | |a Smith, Becky A |e verfasserin |4 aut | |
| 700 | 1 | |a Seidelman, Jessica L |e verfasserin |4 aut | |
| 700 | 1 | |a Lewis, Sarah S |e verfasserin |4 aut | |
| 700 | 1 | |a Advani, Sonali D |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Infection control and hospital epidemiology |d 1988 |g 44(2023), 10 vom: 22. Okt., Seite 1582-1586 |w (DE-627)NLM012701467 |x 1559-6834 |7 nnns |
| 773 | 1 | 8 | |g volume:44 |g year:2023 |g number:10 |g day:22 |g month:10 |g pages:1582-1586 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1017/ice.2023.30 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 44 |j 2023 |e 10 |b 22 |c 10 |h 1582-1586 | ||