Location, Location, Location: A Change in Urine Testing Order Sets on Culturing Practices at an Academic Medical Center Emergency Department

Abstract Background Suboptimal antimicrobial therapy has resulted in the emergence of multi-drug resistant organisms. The objective of this study was to optimize the time to antimicrobial therapy modification for patients discharged from the emergency department (ED) of an academic medical center through implementation of a pharmacist-driven outpatient antimicrobial stewardship initiative (ASI). Methods This was a pre-post, quasi-experimental study that evaluated the impact of a pharmacist-driven outpatient antimicrobial stewardship initiative at a single academic medical center. The pre-cohort was evaluated through manual electronic medical record (EMR) review, while the post-cohort involved a real-time notification alert system through an electronic clinical surveillance application. The difference in time from positive culture result to antimicrobial therapy optimization before and after implementation of the pharmacist-driven ASI was collected and analyzed. Results A total of 166 cultures were included in the analysis. Of these, 12/72 (16%) in the pre-cohort and 11/94 (12%) in the post-cohort required antimicrobial therapy modification, with a 21.9-hour reduction in median time from positive culture result to antimicrobial optimization in the post-cohort (43 h vs. 21.1 h; p < 0.01). Similarly, the median time from positive culture result to review was reduced by 20 hours with pharmacist-driven intervention (21.1 h vs. 1.4 h; p < 0.01). Conclusion The implementation of a pharmacist-driven outpatient antimicrobial stewardship initiative resulted in a significant reduction in time to positive culture review and therapy optimization for patients discharged from the ED of an academic medical center set in Philadelphia, PA. Disclosures All Authors: No reported disclosures

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Care Coordination

50 Studies Every Anesthesiologist Should Know ◽

10.1093/med/9780190237691.003.0031 ◽

2018 ◽

pp. 163-167

Keyword(s):

Emergency Department ◽

Care Coordination ◽

Medical Center ◽

Academic Medical Center ◽

General Medicine ◽

Ethnically Diverse ◽

Medicine Service ◽

Academic Medical ◽

Diverse Patient Population ◽

Hospital Visits

This case focuses on improving care coordination for patients who have been discharged from the hospital by asking the question: Is it possible to reduce the rate of repeat emergency department and hospital visits after discharge by improving care coordination? The study group included adults admitted to the general medicine service of an urban, academic medical center that serves an “ethnically diverse patient population.” Patients were assigned to nurse discharge advocates who provided the patients with delineated services and assistance during the hospitalization The Project Reengineered Discharge (RED) program substantially reduced repeat emergency department and hospital visits by improving care coordination at the time of hospital discharge.

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Implementation of a Rapid Whole Blood D-Dimer Test in the Emergency Department of an Urban Academic Medical Center: Impact on ED Length of Stay and Ancillary Test Utilization

Yearbook of Pathology and Laboratory Medicine ◽

10.1016/s1077-9108(10)79467-6 ◽

2011 ◽

Vol 2011 ◽

pp. 308-309 ◽

Cited By ~ 1

Author(s):

M.G. Bissell

Keyword(s):

Emergency Department ◽

Length Of Stay ◽

Whole Blood ◽

Medical Center ◽

Academic Medical Center ◽

Ancillary Test ◽

Academic Medical ◽

D Dimer

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145: Analysis of Downstream Revenue to an Academic Medical Center From the Emergency Department

Annals of Emergency Medicine ◽

10.1016/j.annemergmed.2010.06.192 ◽

2010 ◽

Vol 56 (3) ◽

pp. S49

Author(s):

T. McGuire ◽

T. Madsen ◽

E. Barton ◽

C. Hopkins

Keyword(s):

Emergency Department ◽

Medical Center ◽

Academic Medical Center ◽

Academic Medical

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Effect of changing urine testing orderables and clinician order sets on inpatient urine culture testing: Analysis from a large academic medical center

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.356 ◽

2019 ◽

Vol 40 (3) ◽

pp. 281-286 ◽

Cited By ~ 11

Author(s):

Satish Munigala ◽

Rebecca Rojek ◽

Helen Wood ◽

Melanie L. Yarbrough ◽

Ronald R. Jackups ◽

...

Keyword(s):

Urine Culture ◽

Medical Center ◽

Academic Medical Center ◽

Tertiary Care ◽

Temporal Trends ◽

Interrupted Time Series ◽

Vital Role ◽

Order Sets ◽

Urine Testing ◽

The Impact

AbstractObjective:To evaluate the impact of changes to urine testing orderables in computerized physician order entry (CPOE) system on urine culturing practices.Design:Retrospective before-and-after study.Setting:A 1,250-bed academic tertiary-care referral center.Patients:Hospitalized adults who had ≥1 urine culture performed during their stay.Intervention:The intervention (implemented in April 2017) consisted of notifications to providers, changes to order sets, and inclusion of the new urine culture reflex tests in commonly used order sets. We compared the urine culture rates before the intervention (January 2015 to April 2016) and after the intervention (May 2016 to August 2017), adjusting for temporal trends.Results:During the study period, 18,954 inpatients (median age, 62 years; 68.8% white and 52.3% female) had 24,569 urine cultures ordered. Overall, 6,662 urine cultures (27%) were positive. The urine culturing rate decreased significantly in the postintervention period for any specimen type (38.1 per 1,000 patient days preintervention vs 20.9 per 1,000 patient days postintervention; P < .001), clean catch (30.0 vs 18.7; P < .001) and catheterized urine (7.8 vs 1.9; P < .001). Using an interrupted time series model, urine culture rates decreased for all specimen types (P < .05).Conclusions:Our intervention of changes to order sets and inclusion of the new urine culture reflex tests resulted in a 45% reduction in the urine cultures ordered. CPOE system format plays a vital role in reducing the burden of unnecessary urine cultures and should be implemented in combination with other efforts.

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