Mackenzie Rae Keintz, Jasmine R Marcelin, Elizabeth Lyden, Mark E Rupp, Trevor C Van Schooneveld
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引用次数: 0
Abstract
Objective: To evaluate the impact of removing the "other" free text special indication from an inpatient urinalysis (UA)-driven reflex urine culture UTI panel on urine culture utilization and special indication designation.
Design: Single-center interrupted time series analysis using segmented regression to assess changes in urine culture ordering before and after intervention.
Setting: Tertiary academic medical center inpatient units, July 1, 2022-October 31, 2025.
Patients: All hospitalized adults with UTI panels during the study period. Urine culture orders from emergency and ambulatory settings were excluded.
Interventions: Removal of the "other" free text special indication from the UTI panel in February 2024. A new "deceased donor" special indication was added to maintain compliance with local organ procurement regulations.
Results: Among 39,218 UTI panels, 11,923 cultures were performed. Postintervention urine cultures decreased by 2.09 per 1,000 patient days (PD) (P <.05), with a significant postintervention downward trend of 0.15 cultures per 1,000 PD per month (P <.05). Special indication designation decreased immediately by 2.17 special indications per 1,000 PD (P <.05) with a reversal of the preintervention upward trend (P <.05). Designation for neutropenia increased by 0.74 indications per 1,000 PD immediately postintervention (P <.05); renal/pancreas transplant and pregnancy indications remained stable or declined. No compensatory increase in total urine cultures was observed.
Conclusions: Removing the "other" free text option in a UTI panel led to a sustained reduction in overall urine culture ordering and low-value special indication designations. Modifying electronic order set architecture represents a feasible diagnostic stewardship strategy to reduce unnecessary testing and potential overtreatment of asymptomatic bacteriuria while preserving pathways for high-risk populations.
目的：评价从住院患者尿液分析（UA）驱动的反射性尿培养（UTI）面板中删除“其他”自由文本特殊适应症对尿培养利用和特殊适应症指定的影响。设计：采用分段回归的单中心中断时间序列分析来评估干预前后尿培养顺序的变化。地点：三级学术医疗中心住院部，2022年7月1日- 2025年10月31日。患者：所有在研究期间有尿路感染的住院成年人。排除急诊和门诊的尿培养嘱。干预措施：2024年2月从UTI面板中删除“其他”自由文本特殊指示。新增“已故捐献者”特别标示，以符合本地器官采购条例。结果：在39,218个UTI组中，进行了11,923个培养。干预后尿培养减少2.09 / 1000患者日（PD） （P P P P P P P）结论：在尿路感染组中删除“其他”自由文本选项导致总体尿培养订单和低价值特殊适应症指定的持续减少。修改电子指令集架构代表了一种可行的诊断管理策略，以减少不必要的测试和潜在的无症状细菌的过度治疗，同时保留高风险人群的途径。
期刊介绍：
Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. Written by infection control practitioners and epidemiologists and guided by an editorial board composed of the nation''s leaders in the field, ICHE provides a critical forum for this vital information.
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