Impact of electronic alerts on repeat urine culture testing: Analysis from a large academic medical center

Urine cultures are commonly ordered among hospitalized patients, and they are often ordered repeatedly, leading to laboratory overutilization and increased cost.1,2 Positive urine cultures are a major driver of unnecessary antibiotic use.3–5 Previous studies have used multiple methods to prevent unnecessary urine testing including education, reflex urine culture cancellation and 2-step urine-culture ordering,6,7 Prior interventions at our institution to prevent unnecessary urine cultures, including modification of “reflex” urine-culture criteria for specimens submitted for urinalysis and modifications of emergency department and inpatient electronic order sets, decreased urine cultures performed by 46.6% and 45%, respectively.8,9 However, data on the effect of changes in electronic order sets and its role on repeated urine testing practices are limited. The hospital used EPIC (Epic Systems, Verona, WI) as its CPOE system. a P-value comparison for period 1 vs period 2. b P-value comparison for period 2 vs period 3. c Tested by autoregressive integrated moving average (ARIMA) analysis. d Logistic regression analysis with June 2, 2018, to April 24, 2019, as a reference period. e Includes specimen collection by suprapubic aspiration, kidney aspiration, percutaneous nephrostomy tube placement, ileal loop, and cystoscopy. [...]relatively minor changes in the order notification system could have significant impact on provider ordering practices.