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[An alternative proposal for managing morphological examination of urinary sediment and increasing its
Cristina Robbiano1,2, Ilenia Infusino1, Federica Braga1,2
1UOC Patologia Clinica, ASST Fatebenefratelli-Sacco, Milano.
Background:
The morphological examination of urinary sediment (MEUS) is traditionally associated with urinalysis (UA), with workload implications and the need for automation of its execution.
Methods:
Considering MEUS as a test requiring specialized knowhow and skill for its execution, since 2005 in our laboratory it is performed for inpatients only upon specific request. Eleven years after, we have analyzed the long-term impact of this approach on the provided service. We evaluated results in the 2009-2016 period, in which our hospital did not undergo any change both in the number of beds and in the clinical case-mix.
Results:
From 2009 to 2013 an average of 2264 MEUS and 10,204 UA per year were ordered, respectively, with an average ratio of 22.2%. Since 2014, a change on computerized order entry involving MEUS caused a further decrease of its requests (in average, 923 per year), which was not associated to a decrease in UA (in average, 9810 per year) (in average, MEUS/UA 9.4%). MEUS requests came mainly from Paediatrics (47.8%), Nephrology (20.9%) and Rheumatology (18.3%) wards. By filling a satisfaction survey, clinical wards evaluated the provided service as satisfactory, while highlighting some critical issues, mainly referred to preanalytical phase.
Conclusions:
The alternative proposal for managing MEUS presented in this paper markedly reduces the number of requests and increases their appropriateness. This is achieved without any negative impact on patient care.
Insights
Implementing a selective request policy for morphological examination of urinary sediment (MEUS) significantly reduced test orders and improved appropriateness without impacting patient care, optimizing laboratory workload.
Area of Science:
- Clinical Chemistry
- Laboratory Medicine
- Medical Diagnostics
Background:
- Morphological examination of urinary sediment (MEUS) is a component of urinalysis (UA).
- MEUS requires specialized expertise, posing workload challenges for laboratories.
- The need for automation and optimized test utilization in diagnostic services is recognized.
Purpose of the Study:
- To evaluate the long-term impact of a selective request policy for MEUS.
- To assess changes in MEUS and UA ordering patterns and appropriateness.
- To determine the effect of the policy on patient care and clinical satisfaction.
Main Methods:
- A selective MEUS request policy was implemented in 2005, restricting testing to inpatient requests.
- Data from 2009-2016 were analyzed, focusing on a period with stable hospital bed numbers and case-mix.
- A satisfaction survey was administered to clinical wards.
Main Results:
- MEUS requests decreased significantly after a 2014 change in computerized order entry, from 22.2% to 9.4% of UA.
- Requests primarily originated from Paediatrics, Nephrology, and Rheumatology.
- Clinical wards reported satisfactory service but noted preanalytical phase issues.
Conclusions:
- The selective management of MEUS markedly reduces test requests and enhances their appropriateness.
- This approach optimizes laboratory resources without negatively affecting patient care.
- Further improvements may focus on addressing preanalytical phase challenges.
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