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Reducing inappropriate urine testing at Hutt Valley District Health Board using Choosing Wisely principles
Aidan D Wilson1, Matthew J Kelly2, Emma Henderson3
1University of Otago, Wellington.
The New Zealand Medical Journal
|December 19, 2019
Summary
Reducing unnecessary urine culture tests by removing dipsticks and educating staff significantly cut requests by 28% without increasing urinary tract infections (UTIs). This strategy effectively combats antibiotic overuse for asymptomatic bacteriuria.
Area of Science:
- Healthcare quality improvement
- Clinical microbiology
- Antimicrobial stewardship
Background:
- Asymptomatic bacteriuria often leads to unnecessary urine culture testing and antibiotic treatment.
- The Hutt Valley District Health Board aimed to curb clinically inappropriate urine culture requests.
- Choosing Wisely principles guided the intervention strategy.
Purpose of the Study:
- To quantitatively evaluate the effectiveness of removing urine dipsticks and staff education in reducing urine culture requests.
- To assess the impact of these interventions on the diagnosis and treatment of urinary tract infections (UTIs).
Main Methods:
- A quasi-experimental study analyzed urine culture data from January 2015 to October 2017.
- Inpatient data was compared to outpatient data (control group).
- Urinary tract infection (UTI) diagnoses served as a measure of potential negative impacts.
Main Results:
- A 28% reduction in monthly inpatient urine culture requests was observed post-intervention.
- The proportion of positive urine cultures increased slightly (23.0% to 25.2%).
- Hospital discharge diagnoses for UTIs decreased by 17%.
Conclusions:
- Removing urine dipsticks and educating staff are effective strategies to reduce unnecessary urine culture testing.
- These interventions help decrease antibiotic overuse for asymptomatic bacteriuria without negatively impacting UTI rates.
- The approach is scalable to other healthcare settings to reduce unnecessary care and overdiagnosis.
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