Quality Improvement through Reduction in Urine Culture Test Utilization

From the 2018 HVPAA National Conference

Matthew Miller (Lehigh Valley Health Network)

Background

At Lehigh Valley Health Network, it was identified that we were experiencing high rates of catheter-associated UTIs.  In working with the Test Utilization Committee, changes were made to the urine culture order to guide providers to appropriate ordering of urine cultures, thereby reducing over-surveillance of CAUTIs.

Objectives

Reduce over-surveillance of CAUTIs in the network.

Reduce urine culture ordering to focus on appropriateness criteria.

Decrease urine culture costs for the network.

Methods

The Test Utilization Committee identified changes to the urine culture in the EMR that would drive appropriate ordering based upon IDSA recommendations.  Clinical decision support was incorporated into the urine culture orders.  Best Practice Advisories (BPAs) were utilized as follow-up if providers continued to pursue urine culture ordering despite no valid indication.

WebI tools were utilized to identify data and the Test Utilization Committee collaborated with our network lab entity to collect and verify clinical and cost data.

Results

The average number of urine cultures performed for the 6 months prior to education starting in February 2017 was 2331/month.  The average number of urine cultures performed for the 3 months after the EMR changes had been in place was 1536/month.  Given a charge to the network of $18.17, over 3 months, there was a cost savings of $43.335.45.  Projected savings over 12 months is over $173,340.  CAUTIs significantly decreased over time from a multi-modal approach.

Conclusion

Over time, urine culture utilization decreased while matching the appropriate use criteria for ordering.  The network incorporated changes in the EMR to decrease over-surveillance of UTIs (especially CAUTIs) while reducing costs.

Implications for the Patient

The focus on the network to reduce CAUTIs included modifications to the ordering of urine cultures.  This focused on appropriateness use criteria, reducing over-surviellance of UTIs and over-treatment with antibiotics.

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