Why Are We Frequently Ordering Urinalyses in Patients without Symptoms of Urinary Tract Infections in the Emergency Department?

Horrik, Tessa M. Z. X. K. van; Laan, Bart J.; Huizinga, Allard B.; Hoitinga, Gercora; Poortvliet, Walter P.; Geerlings, Suzanne E.

doi:10.3390/ijerph191710757

Cited by 6 publications

(2 citation statements)

References 21 publications

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“…Barriers and enablers were the focus of 12 qualitative,48–59 8 quantitative60–67 and 4 mixed-methods studies 68–71. Studies of barriers and enablers explored testing/treatment in infant bronchiolitis,54 55 68 antibiotic stewardship,53 56 57 62 70 cranial CT scans in minor head injury,49 52 guideline implementation in chest pain51 and syncope,69 urinalysis,56 67 urinary catheter insertion,50 lumbar radiographs in back pain,48 respiratory viral testing,54 potentially inappropriate medications in older patients58 and perspectives about low-value care 59 60 64–66 71…”

Section: Resultsmentioning

confidence: 99%

What works for and what hinders deimplementation of low-value care in emergency medicine practice? A scoping review

Gangathimmaiah,

Drever,

Evans

et al. 2023

BMJ Open

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ObjectivesLow-value care can harm patients and healthcare systems. Despite a decade of global endeavours, low value care has persisted. Identification of barriers and enablers is essential for effective deimplementation of low-value care. This scoping review is an evidence summary of barriers, enablers and features of effective interventions for deimplementation of low-value care in emergency medicine practice worldwide.DesignA mixed-methods scoping review was conducted using the Arksey and O’Malley framework.Data sourcesMedline, CINAHL, Embase, EMCare, Scopus and grey literature were searched from inception to 5 December 2022.Eligibility criteriaPrimary studies which employed qualitative, quantitative or mixed-methods approaches to explore deimplementation of low-value care in an EM setting and reported barriers, enablers or interventions were included. Reviews, protocols, perspectives, comments, opinions, editorials, letters to editors, news articles, books, chapters, policies, guidelines and animal studies were excluded. No language limits were applied.Data extraction and synthesisStudy selection, data collection and quality assessment were performed by two independent reviewers. Barriers, enablers and interventions were mapped to the domains of the Theoretical Domains Framework. The Mixed Methods Appraisal Tool was used for quality assessment.ResultsThe search yielded 167 studies. A majority were quantitative studies (90%, 150/167) that evaluated interventions (86%, 143/167). Limited provider abilities, diagnostic uncertainty, lack of provider insight, time constraints, fear of litigation, and patient expectations were the key barriers. Enablers included leadership commitment, provider engagement, provider training, performance feedback to providers and shared decision-making with patients. Interventions included one or more of the following facets: education, stakeholder engagement, audit and feedback, clinical decision support, nudge, clinical champions and training. Multifaceted interventions were more likely to be effective than single-faceted interventions. Effectiveness of multifaceted interventions was influenced by fidelity of the intervention facets. Use of behavioural change theories such as the Theoretical Domains Framework in the published studies appeared to enhance the effectiveness of interventions to deimplement low-value care.ConclusionHigh-fidelity, multifaceted interventions that incorporated education, stakeholder engagement, audit/feedback and clinical decision support, were administered daily and lasted longer than 1 year were most effective in achieving deimplementation of low-value care in emergency departments. This review contributes the best available evidence to date, but further rigorous, theory-informed, qualitative and mixed-methods studies are needed to supplement the growing body of evidence to effectively deimplement low-value care in emergency medicine practice.

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Section: Resultsmentioning

confidence: 99%

What works for and what hinders deimplementation of low-value care in emergency medicine practice? A scoping review

Gangathimmaiah,

Drever,

Evans

et al. 2023

BMJ Open

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“…Emerging rapid diagnostic methodologies, including biosensor-based platforms and microfluidics, are being developed to address the diagnostic delays caused by the standard 48 h turnaround time for urine culture results. It is important to mention that a key component of ASPs for UTIs in ED is reducing the number of unnecessary urine cultures ordered [60]. In the ED, urine cultures are often ordered for a variety of indications, and a positive urine culture for patients with nonspecific UTI symptoms can be a misleading finding, which can lead to unnecessary antimicrobial treatment [61].…”

Section: Rapid Diagnostic Testsmentioning

confidence: 99%

The Interventions and Challenges of Antimicrobial Stewardship in the Emergency Department

Ruiz-Ramos,

Escolà-Vergé,

Monje-López

et al. 2023

Antibiotics

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Over the last decades, we have witnessed a constant increase in infections caused by multi-drug-resistant strains in emergency departments. Despite the demonstrated effectiveness of antimicrobial stewardship programs in antibiotic consumption and minimizing multi-drug-resistant bacterium development, the characteristics of emergency departments pose a challenge to their implementation. The inclusion of rapid diagnostic tests, tracking microbiological results upon discharge, conducting audits with feedback, and implementing multimodal educational interventions have proven to be effective tools for optimizing antibiotic use in these units. Nevertheless, future multicenter studies are essential to determine the best way to proceed and measure outcomes in this scenario.

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A step forward in the diagnosis of urinary tract infections: from machine learning to clinical practice

Flores,

Martínez-Racaj,

Blasco

et al. 2024

Computational and Structural Biotechnology Journal

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Why Are We Frequently Ordering Urinalyses in Patients without Symptoms of Urinary Tract Infections in the Emergency Department?

Cited by 6 publications

References 21 publications

What works for and what hinders deimplementation of low-value care in emergency medicine practice? A scoping review

What works for and what hinders deimplementation of low-value care in emergency medicine practice? A scoping review

The Interventions and Challenges of Antimicrobial Stewardship in the Emergency Department

A step forward in the diagnosis of urinary tract infections: from machine learning to clinical practice

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