A mixed methods service improvement project to investigate the motivational reasons why swab and urine samples are sent for microbiological analysis

Background

Excessive urine and swab sampling has a direct impact on environmental health, resource availability, sample turnaround time and patient care. Positive cultures from unnecessary samples can lead to inappropriate antimicrobial use and a cascade of further investigations. This project aims to identify the motivational reasons behind swab and urine sample requests in the hospital and community setting, with the aim of reducing unnecessary testing.

Methods

A mixed methods approach using a survey followed by qualitative interviews was used. A 16–part online questionnaire was distributed among various health care professionals in primary and secondary care. Upon completion participants were offered the opportunity to volunteer to participate in structured follow up interviews. A number of participants were selected for qualitative interviews.

Results

Eighty eight participants completed the questionnaire and five were interviewed. Both the questionnaire and interviews highlighted a wide diversity in the practice of how and why swabs and urine samples are submitted for microbiological analysis. The interviews yielded many ideas for improvements to practice including training and protocol recommendations.

Conclusion

The results show a lack of clarity with regards to the primary responsibility for requesting samples. The study identified that this decision is often based on clinical experience, rather than protocol. The time at which a sample is reviewed and treatment, for example antibiotics, is started can vary among the healthcare professionals. Interview participants expressed a need for training, so long as this was tailored to different specialties’ patient populations.