Impact of order set design on urine culturing practices at an academic medical centre emergency department
| Autor: | Robert F Poirier, S. Reza Jafarzadeh, David K. Warren, Ronald Jackups, Stephen Y. Liang, Satish Munigala, Helen Wood |
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| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Urinalysis Urine Unnecessary Procedures Urine testing Medical Order Entry Systems Urine microscopy Post-intervention Young Adult 03 medical and health sciences 0302 clinical medicine Humans Medicine Infection control 030212 general & internal medicine Practice Patterns Physicians' Aged Academic Medical Centers medicine.diagnostic_test business.industry Health Policy 030208 emergency & critical care medicine Emergency department Middle Aged Quality Improvement Emergency medicine Female Emergency Service Hospital business Order set |
| Zdroj: | BMJ Quality & Safety. 27:587-592 |
| ISSN: | 2044-5423 2044-5415 |
| DOI: | 10.1136/bmjqs-2017-006899 |
| Popis: | BackgroundUrinalysis and urine culture are commonly ordered tests in the emergency department (ED). We evaluated the impact of removal of order sets from the ‘frequently ordered test’ in the computerised physician order entry system (CPOE) on urine testing practices.MethodsWe conducted a before (1 September to 20 October 2015) and after (21 October to 30 November 2015) study of ED patients. The intervention consisted of retaining ‘urinalysis with reflex to microscopy’ as the only urine test in a highly accessible list of frequently ordered tests in the CPOE system. All other urine tests required use of additional order screens via additional mouse clicks. The frequency of urine testing before and after the intervention was compared, adjusting for temporal trends.ResultsDuring the study period, 6499 (28.2%) of 22 948 ED patients had ≥1 urine test ordered. Urine testing rates for all ED patients decreased in the post intervention period for urinalysis (291.5 pre intervention vs 278.4 per 1000 ED visits post intervention, P=0.03), urine microscopy (196.5vs179.5, P=0.001) and urine culture (54.3vs29.7, PConclusionsA simple intervention of retaining only ‘urinalysis with reflex to microscopy’ and removing all other urine tests from the ‘frequently ordered’ window of the ED electronic order set decreased urine cultures ordered by 46.6% after accounting for temporal trends. Given the injudicious use of antimicrobial therapy for asymptomatic bacteriuria, findings from our study suggest that proper design of electronic order sets plays a vital role in reducing excessive ordering of urine cultures. |
| Databáze: | OpenAIRE |
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