Refining reflex urine culture testing in the ED

Screening for urinary tract infections is often performed by urinalysis (UA) which measures specific urine elements such as nitrites, white blood cells (WBC), and leukocyte esterase (LE). Education on when to screen for and treat a UTI, based on Infectious Disease Society of America guidelines, was provided at Emergency Medicine department meetings to ED attending physicians, administration and leadership, and midlevel providers [1-4]. Providing education on when it is appropriate to screen for and treat a UTI, updating pre-checked order sets, and increasing reflex to culture thresholds led to a decreased number of negative urine cultures, reducing the high cost of quality waste from inappropriate urine culture testing in the ED.