Strebe Joslyn, Wong Emily, Ma Rosalind, Nguyen Jackie, Dang Michael, Morgan Kristi, Hall Shawn, Prokesch Bonnie C
Department of Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Open Forum Infect Dis. 2025 Apr 16;12(5):ofaf228. doi: 10.1093/ofid/ofaf228. eCollection 2025 May.
Urinalyses and urine cultures (UCs) are frequently ordered simultaneously in emergency departments (EDs) to increase efficiency and decrease triaging times. However, this often comes at the cost of overdiagnosis and overtreatment of urinary tract infections. Our study examines the rates of UC orders and hospital savings after implementation of a reflex UC system in a large safety-net county hospital ED. Differences in rates of antibiotic use are also described.
The electronic medical records of eligible patients were analyzed before and after implementation of a reflex UC ordering system, and rates of UC processing were documented to estimate savings to the hospital and the healthcare payer. As a secondary analysis, 7 days of medical records both before and after intervention were reviewed to describe absolute rates of antibiotic prescribing and adverse events attributed to antibiotics.
Data analysis of 9 months after initiation of a reflex UC protocol revealed a decrease in the average of monthly cultures processed by 20.3%, resulting in a hospital cost savings of $425 000 with savings to the healthcare payer on the order of $5 650 000 in prevented cultures alone. Secondary analysis revealed a small but not statistically significant decrease in the number of antibiotics prescribed after intervention (from 40.76% to 38.11%) with similar rates of adverse effects.
Implementation of a reflex UC protocol in the ED of a large safety-net hospital resulted in a decrease of the number of cultures being processed, leading to substantial healthcare savings, which is particularly important in a resource-limited setting. While the implementation of the protocol resulted in cost savings due to diagnostic stewardship, the impact of such a protocol on antibiotic stewardship requires further study.
在急诊科（ED），尿常规分析和尿培养（UC）经常同时进行，以提高效率并缩短分诊时间。然而，这往往以尿路感染的过度诊断和过度治疗为代价。我们的研究考察了在一家大型安全网县医院急诊科实施自动尿培养系统后尿培养医嘱的开具率以及医院节省的费用。同时还描述了抗生素使用率的差异。
对符合条件的患者在实施自动尿培养医嘱系统前后的电子病历进行分析，并记录尿培养处理率，以估算医院和医疗支付方节省的费用。作为次要分析，对干预前后7天的病历进行审查，以描述抗生素处方的绝对率和归因于抗生素的不良事件。
对启动自动尿培养方案9个月后的数据分析显示，每月平均处理的培养次数减少了20.3%，医院节省了42.5万美元，仅预防培养一项就为医疗支付方节省了约565万美元。次要分析显示，干预后开具的抗生素数量略有下降但无统计学意义（从40.76%降至38.11%），不良反应发生率相似。
在一家大型安全网医院的急诊科实施自动尿培养方案，减少了处理的培养次数，带来了可观的医疗费用节省，这在资源有限的环境中尤为重要。虽然该方案的实施因诊断管理而节省了成本，但其对抗生素管理的影响仍需进一步研究。
