From the 2024 HVPA National Conference
Nikita Dahake MD (Temple University Hospital Department of Internal Medicine), Rachel Strock MD, Tyler Russeth MD, Rachel Thomas MD, Megan Garver MD, Dharmini Shah Pandya MD, Monica Patel DO
Background:
Urine labs are critical in guiding clinical decision-making and serve as an important diagnostic tool for admitted patients. Prolonged urinary lab collection time can lead to delayed diagnoses and interventions, continuation of unnecessary antibiotics, and prolonged hospital stays. At our tertiary referral center, we identified prompt collection of urine studies as a daily barrier to effective patient care. Our group examined the hospital workflow involving specimen collection and identified several barriers including staffing shift change and unit changes, unintended specimen disposal by other staff members, and patient incontinence or retention of urine.
Objective:
We aimed to improve the time interval between urine lab orders to collection. We created an electronic medical record reminder system that targeted patient care assistants (PCAs) who often aid nursing staff with specimen collection. With implementation of this system reminder, we hoped to improve inter-disciplinary communication to promote timely patient care and safety.
Methods:
We utilized stakeholder observations to obtain the current state of the process of urine collection. Then we did a root cause analysis that led us to find that not all healthcare staff had urine specimen collection on their task list. With the assistance of the Epic team, a new electronic medical record (EMR) column labeled “Uncollected Urine Specimens” was created. This new feature added a red dot next to the patient’s name when a urine specimen was required. The PCAs were instructed to add this to their patient list as a reminder that these studies were needed. Once a specimen was collected, the red dot would disappear. This new addition was introduced during morning huddles on two medical-surgical units. Data was collected over three months prior to and one month after this intervention. Specifically, the time interval between order time and collection was observed.
Results:
A total of 458 and 109 urinalysis orders were ordered and collected during the pre- and post-intervention time, respectively. One urinalysis from each group was eliminated due to exceeding more than 48 hours since order placement. The average time interval between urinalysis order to collect was reduced from 6.6 hours to 1.6 hours following intervention (p < 0.05). Unit 1 was on average 1.4 hours faster in collection time compared to unit 2 in the pre-intervention phase (p < 0.05). There was no difference in the post-intervention phase between each unit (p < 0.05).
Conclusion:
Interventions utilizing a multidisciplinary approach focused on improved communication led to faster collection of urine specimens. Greater involvement of PCAs through the addition of a new EMR column allowed for this group to initiate collection of urine studies and minimized the likelihood of improper disposal of samples.
Clinical Implications:
Our study reduced the time interval between urine order and collection time. This time reduction can improve antibiotic stewardship, allow for early recognition of the source of sepsis, and expedite consultation to specialty services. Further studies will look at the direct impact of the decreased time to collection on these clinical outcomes.