Optimizing Provider Test Ordering and Patient Outcomes Through Best Practice Alerts and Doctorate in Clinical Laboratory Sciences (DCLS) Consultation for Urine Cultures

Recent initiatives have discouraged the treatment of asymptomatic bacteriuria in specific patient populations due to its lack of clinical benefit, no improvement in morbidity or mortality, and its contribution to antibiotic overuse. This study aimed to evaluate whether an intervention at order entry, combined with DCLS laboratory consultation for urine cultures and urinalyses, could reduce unnecessary lab tests and inappropriate antibiotic use, thereby improving patient outcomes. Our research design was a quasi-experimental study with a retrospective and prospective chart review on non-pregnant adult patients 18 years of age and older from July 2021 to September 2022. Data collected for both reviews included patient demographics, provider demographics, patient signs and symptoms, laboratory test results, test order type, test order utilization and antibiotic prescriptions. Our study included 6372 patients, with 3408 in the retrospective review and 2964 in the prospective review. Before the intervention, 60% (n = 2053) of test orders were inappropriate, which decreased to 20% (n = 591) post-intervention. In asymptomatic patients, reflexed urine cultures decreased from 51% to 13% post-intervention. Lastly, in asymptomatic patients, antibiotic therapy at discharge dropped from 54% to 25% after the intervention. Post-intervention ordering practices improved, decreasing the number of inappropriate orders across all patient and provider types. Overall, this initiative showed a significant reduction in the treatment of asymptomatic bacteriuria, which has been linked to the overuse of antibiotic therapy.