Using clinical decision support to improve urine testing and antibiotic utilization.

Urine cultures from catheterized patients often yield false positives due to colonization rather than infection. Prior research has shown that catheter use increases the risk of contamination during specimen collection. However, no prior work had resolved how to reduce unnecessary testing and antibiotic use in this context. It was already known that catheterized patients are more likely to receive urine cultures regardless of clinical need. This gap motivated the development of tools to guide appropriate testing. No prior work had resolved how to integrate clinical guidance into the ordering process. It was already known that antibiotic overuse contributes to resistance. That uncertainty drove the need for a system-level intervention. No prior work had resolved how to reduce inappropriate catheter use through decision support.

This study aimed to assess the impact of a clinical decision support (CDS) tool on urine culture ordering and antibiotic use in catheterized patients. The specific problem was the high rate of unnecessary testing and treatment in catheterized individuals. The motivation was to reduce unnecessary interventions and improve diagnostic accuracy. The researchers proposed that integrating catheter-related guidance into the electronic health record could improve practice. The goal was to evaluate whether CDS could reduce inappropriate testing and antibiotic use. The study focused on catheterized patients due to their higher risk of false positives. The researchers proposed that the CDS could also promote catheter removal when appropriate. The study aimed to evaluate outcomes before and after implementation.

The study used a before-and-after design across three hospitals in North Carolina. A CDS tool was integrated into the electronic health record for urine culture orders. The tool provided education on appropriate indications for culture. It also suggested catheter removal or exchange for catheters over seven days old. The researchers used interrupted time-series analysis with Poisson regression. They evaluated changes in urine culture orders and antibiotic use. They also tracked catheter removal decisions and safety events. The study period included both pre- and postintervention data.

The CDS tool was prompted in 38,361 urine culture orders across all patients. Among catheterized patients, it was triggered 2,133 times in the postintervention period. Urine culture orders decreased by 1.4% per month (P < .001). Antibiotic use for UTI indications dropped by 2.3% per month (P = .006). No significant decline in catheter-associated urinary tract infection (CAUTI) rates was observed. Clinicians removed catheters in 8.5% of cases where suggested. No safety events were reported following catheter removal or reinsertion. The CDS was associated with reduced testing and treatment without increased risk.

The CDS tool was associated with reduced urine culture orders and antibiotic use for UTI indications. The researchers propose that the tool improved diagnostic appropriateness in catheterized patients. They suggest that CDS can serve as a reminder for catheter removal or exchange. The tool did not lead to increased CAUTI rates in the postintervention period. The authors state that CDS can optimize urine culture collection practices. No prior work had resolved how to integrate catheter guidance into testing decisions. The findings suggest that CDS can reduce unnecessary interventions without compromising safety. The authors propose that such tools could be widely adopted in similar clinical settings.