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Reducing Low Value Care Through Implementation of a Clinical Decision Support Tool Addressing Urine Culture in a

Tim Fondum1, John Cheek1

  • 1Emergency Department, Royal Children's Hospital, Melbourne, Australia.

Studies in Health Technology and Informatics
|July 16, 2026
PubMed

Insights

A clinical decision support tool reduced unnecessary urine cultures by 25% in a pediatric emergency department. This intervention led to sustained decreases in urine culture orders over twelve months.

Area of Science:

  • Pediatric Emergency Medicine
  • Clinical Decision Support Systems
  • Infectious Disease Diagnostics

Background:

  • Unnecessary urine cultures contribute to antimicrobial resistance and healthcare costs.
  • Effective clinical decision support tools are needed to optimize diagnostic test ordering in pediatric emergency settings.

Purpose of the Study:

  • To evaluate the impact of an interruptive alert as a clinical decision support tool on urine culture ordering rates.
  • To assess changes in urine culture ordering and results following the implementation of the alert system.

Main Methods:

  • Implementation of an interruptive alert within the electronic health record system.
  • Prospective analysis of urine culture ordering data before and after alert implementation.
  • Monitoring of culture results, specifically focusing on pure growth.

Main Results:

  • An immediate and sustained 25% reduction in urine culture ordering rates was observed.
  • A small increase in the proportion of cultures with pure growth was noted during the twelve-month study period.

Conclusions:

  • Interruptive alerts are effective clinical decision support tools for reducing unnecessary urine cultures in pediatric emergency departments.
  • This intervention demonstrates a successful strategy for optimizing diagnostic test utilization and potentially mitigating antimicrobial resistance concerns.

Keywords:
change managementclinical decision supportclinical systems implementationdigital healthuser-centred design methods

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