Enhancing urine culture ordering practices through implementation of a urine culture order note at an academic Veterans Affairs medical center.

Abstract

Objectives: Urine cultures have been ordered inappropriately among many asymptomatic hospitalized patients. This study aimed to assess how a new urine culture order note incorporated into an electronic health record system impacted the number and appropriateness of urine cultures performed.

Design: A quasi-experimental before-and-after intervention.

Setting: The study was conducted at the Veterans Affairs Connecticut Healthcare System (VACTHS) in West Haven, Connecticut.

Patients: The study included hospitalized adult patients who had urine cultures performed from January 1^st, 2023, to October 31^st, 2024.

Intervention: The intervention was the addition of a mandatory urine culture order note that linked to a urine culture order in the electronic health record. The note required providers to choose an indication for ordering a urine culture. The study outcomes were the percentage of appropriateness associated with urine cultures and the number of urine cultures per 100 admissions performed pre- and post-intervention.

Results: Following the initiation of the mandatory urine culture order note, the percentage of appropriateness increased from 20.6% before the intervention to 59.6% after the intervention (P < .01). The average monthly number of urine cultures per 100 admissions performed decreased from 18.6 before the intervention to 10 after the intervention, a significant 46.3% reduction.

Conclusion: The implementation of a mandatory urine culture order note linked to the urine culture order resulted in increased urine culture order appropriateness and a significant decrease in number of orders for urine cultures.