A Pilot Study to Evaluate the Impact of a Nurse-Driven Urine Culture Diagnostic Stewardship Intervention on Urine Cultures in the Acute Care Setting

Valeria Fabre, Ashley Pleiss, Eili Klein, Zoe Demko, Alejandra Salinas, George Jones, Avinash Gadala, Lauri A. Hicks, Melinda M. Neuhauser, Arjun Srinivasan, Sara E. Cosgrove

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The role of nurses in diagnostic stewardship in hospitals remains largely unknown. Methods: In this before-after study, researchers assessed the impact of a nurse-driven urine culture (UrCx) stewardship intervention for adults with and without urinary catheters on a general medicine unit of a large hospital. The intervention included education on principles of diagnostic stewardship, identification of a nurse champion to serve as liaison between nursing and the antibiotic stewardship program, and implementation of an algorithm to guide discussions with hospitalists about situations when UrCx may not be needed. The primary outcome was the total number of UrCx. The secondary outcome was the rate of inappropriate UrCx. Changes in UrCx rates per 100 patient-days before and after the intervention were calculated using incidence rate ratios (IRRs). Balancing metrics included readmission within 30 days of unit discharge, length of hospital stay, and all-cause in-hospital mortality. Results: With the intervention, the mean UrCx rate per 100 patient-days decreased from 2.30 to 1.52 (IRR = 0.66, 95% confidence interval [CI] = 0.50–0.87, p < 0.01), while in the control unit it increased from 2.17 to 3.10 (IRR = 1.50, 95% CI = 1.22–1.84, p < 0.01). In the intervention unit, the rate of inappropriate UrCx was 0.83 and 0.71 before and after algorithm implementation (IRR = 0.88, 95% CI = 0.58–1.33, p = 0.55). Conclusion: Nursing education and a clinical tool to enhance discussions on the necessity of UrCx among nurses and hospitalists were associated with a reduction in UrCx.

Original languageEnglish (US)
Pages (from-to)650-655
Number of pages6
JournalJoint Commission Journal on Quality and Patient Safety
Volume46
Issue number11
DOIs
StatePublished - Nov 2020

ASJC Scopus subject areas

  • Leadership and Management

Fingerprint Dive into the research topics of 'A Pilot Study to Evaluate the Impact of a Nurse-Driven Urine Culture Diagnostic Stewardship Intervention on Urine Cultures in the Acute Care Setting'. Together they form a unique fingerprint.

Cite this