Cargando…

585. A Cost-Effective Implementation Reducing The Number Of Urine Cultures In An Acute Care Community Hospital

BACKGROUND: Asymptomatic bacteriuria is a common finding in hospitalized patients. This is defined as bacteriuria of ≥10(5) colony-forming units (cfu) per mL without any genitourinary signs or symptoms. Treatment for such leads to increased antimicrobial resistance and is especially common in the in...

Descripción completa

Detalles Bibliográficos
Autores principales: Jain, Rohit, Sahu, Nitasa, Marsh, Denise, Raines, Shannon, Jones, Kirk, Vunnam, Ramarao, Bhatt, Dhirisha, Golamari, Reshma, Hussein, Rezhan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777065/
http://dx.doi.org/10.1093/ofid/ofaa439.779
_version_ 1783630819160489984
author Jain, Rohit
Sahu, Nitasa
Marsh, Denise
Raines, Shannon
Jones, Kirk
Vunnam, Ramarao
Bhatt, Dhirisha
Golamari, Reshma
Hussein, Rezhan
author_facet Jain, Rohit
Sahu, Nitasa
Marsh, Denise
Raines, Shannon
Jones, Kirk
Vunnam, Ramarao
Bhatt, Dhirisha
Golamari, Reshma
Hussein, Rezhan
author_sort Jain, Rohit
collection PubMed
description BACKGROUND: Asymptomatic bacteriuria is a common finding in hospitalized patients. This is defined as bacteriuria of ≥10(5) colony-forming units (cfu) per mL without any genitourinary signs or symptoms. Treatment for such leads to increased antimicrobial resistance and is especially common in the inpatient setting. One study showed a lack of appropriate clinical indication to order a urinalysis in more than half of the patients. In order to expedite a patient’s care, it is common to order a urinalysis and urine culture together and await the results. One study evaluated the impact of changing the order set in inpatients and yielded a 45% reduction in the urine cultures ordered and cost savings as high as $103,845. Reflex testing is used to facilitate effective and efficient patients care while remaining compliant with state and federal regulations in the ordering of lab test. METHODS: Starting October 25, 2019, the electronic medical record order set was changed so there were only 2 options from the previous 9 options. The modified options included a “Urine analysis with reflex culture” and “Urine analysis with microscopy.” The reflex was not encouraged to be used for those who were pregnant, neutropenic, or had any evidence of immunocompromise. RESULTS: Following the implementation of this initiative in October 2019, there was a decrease in overall urine culture cost. From Jan 2019 to September 2019, the cost ranged between $13428.96 to $15157.44/month in the Emergency Department. On the inpatient side, it ranged between $5141.12 to $6559.36/month. After revision of the new order set, the ED cost had dropped to as low as $5672.96/month and $3811.52/month for inpatients. This is a cost reduction of approximately $9484.48 and $2747.84 for the ED and inpatient, respectively.The total number of cultures also reduced from an average of 326/month in the ED to 193/month. The inpatient number of cultures dropped from an average of 130/month to 102/month. CONCLUSION: Modifying the process of urine culture ordering has significantly cut down cost for both the hospital and patient. With clear education and modification of the electronic medical record, such interventions can dramatically improve the unnecessary testing for UTI’s. DISCLOSURES: All Authors: No reported disclosures
format Online
Article
Text
id pubmed-7777065
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Oxford University Press
record_format MEDLINE/PubMed
spelling pubmed-77770652021-01-07 585. A Cost-Effective Implementation Reducing The Number Of Urine Cultures In An Acute Care Community Hospital Jain, Rohit Sahu, Nitasa Marsh, Denise Raines, Shannon Jones, Kirk Vunnam, Ramarao Bhatt, Dhirisha Golamari, Reshma Hussein, Rezhan Open Forum Infect Dis Poster Abstracts BACKGROUND: Asymptomatic bacteriuria is a common finding in hospitalized patients. This is defined as bacteriuria of ≥10(5) colony-forming units (cfu) per mL without any genitourinary signs or symptoms. Treatment for such leads to increased antimicrobial resistance and is especially common in the inpatient setting. One study showed a lack of appropriate clinical indication to order a urinalysis in more than half of the patients. In order to expedite a patient’s care, it is common to order a urinalysis and urine culture together and await the results. One study evaluated the impact of changing the order set in inpatients and yielded a 45% reduction in the urine cultures ordered and cost savings as high as $103,845. Reflex testing is used to facilitate effective and efficient patients care while remaining compliant with state and federal regulations in the ordering of lab test. METHODS: Starting October 25, 2019, the electronic medical record order set was changed so there were only 2 options from the previous 9 options. The modified options included a “Urine analysis with reflex culture” and “Urine analysis with microscopy.” The reflex was not encouraged to be used for those who were pregnant, neutropenic, or had any evidence of immunocompromise. RESULTS: Following the implementation of this initiative in October 2019, there was a decrease in overall urine culture cost. From Jan 2019 to September 2019, the cost ranged between $13428.96 to $15157.44/month in the Emergency Department. On the inpatient side, it ranged between $5141.12 to $6559.36/month. After revision of the new order set, the ED cost had dropped to as low as $5672.96/month and $3811.52/month for inpatients. This is a cost reduction of approximately $9484.48 and $2747.84 for the ED and inpatient, respectively.The total number of cultures also reduced from an average of 326/month in the ED to 193/month. The inpatient number of cultures dropped from an average of 130/month to 102/month. CONCLUSION: Modifying the process of urine culture ordering has significantly cut down cost for both the hospital and patient. With clear education and modification of the electronic medical record, such interventions can dramatically improve the unnecessary testing for UTI’s. DISCLOSURES: All Authors: No reported disclosures Oxford University Press 2020-12-31 /pmc/articles/PMC7777065/ http://dx.doi.org/10.1093/ofid/ofaa439.779 Text en © The Author 2020. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Poster Abstracts
Jain, Rohit
Sahu, Nitasa
Marsh, Denise
Raines, Shannon
Jones, Kirk
Vunnam, Ramarao
Bhatt, Dhirisha
Golamari, Reshma
Hussein, Rezhan
585. A Cost-Effective Implementation Reducing The Number Of Urine Cultures In An Acute Care Community Hospital
title 585. A Cost-Effective Implementation Reducing The Number Of Urine Cultures In An Acute Care Community Hospital
title_full 585. A Cost-Effective Implementation Reducing The Number Of Urine Cultures In An Acute Care Community Hospital
title_fullStr 585. A Cost-Effective Implementation Reducing The Number Of Urine Cultures In An Acute Care Community Hospital
title_full_unstemmed 585. A Cost-Effective Implementation Reducing The Number Of Urine Cultures In An Acute Care Community Hospital
title_short 585. A Cost-Effective Implementation Reducing The Number Of Urine Cultures In An Acute Care Community Hospital
title_sort 585. a cost-effective implementation reducing the number of urine cultures in an acute care community hospital
topic Poster Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7777065/
http://dx.doi.org/10.1093/ofid/ofaa439.779
work_keys_str_mv AT jainrohit 585acosteffectiveimplementationreducingthenumberofurineculturesinanacutecarecommunityhospital
AT sahunitasa 585acosteffectiveimplementationreducingthenumberofurineculturesinanacutecarecommunityhospital
AT marshdenise 585acosteffectiveimplementationreducingthenumberofurineculturesinanacutecarecommunityhospital
AT rainesshannon 585acosteffectiveimplementationreducingthenumberofurineculturesinanacutecarecommunityhospital
AT joneskirk 585acosteffectiveimplementationreducingthenumberofurineculturesinanacutecarecommunityhospital
AT vunnamramarao 585acosteffectiveimplementationreducingthenumberofurineculturesinanacutecarecommunityhospital
AT bhattdhirisha 585acosteffectiveimplementationreducingthenumberofurineculturesinanacutecarecommunityhospital
AT golamarireshma 585acosteffectiveimplementationreducingthenumberofurineculturesinanacutecarecommunityhospital
AT husseinrezhan 585acosteffectiveimplementationreducingthenumberofurineculturesinanacutecarecommunityhospital