No “other” way: modification of urinalysis-driven reflex urine culture protocol to reduce inpatient urine cultures

Abstract Objective: To evaluate the impact of removing the “other” free text special indication from an inpatient urinalysis (UA)-driven reflex urine culture UTI panel on urine culture utilization and special indication designation. Design: Single-center interrupted time series analysis using segmented regression to assess changes in urine culture ordering before and after intervention. Setting: Tertiary academic medical center inpatient units, July 1, 2022–October 31, 2025. Patients: All hospitalized adults with UTI panels during the study period. Urine culture orders from emergency and ambulatory settings were excluded. Interventions: Removal of the “other” free text special indication from the UTI panel in February 2024. A new “deceased donor” special indication was added to maintain compliance with local organ procurement regulations. Results: Among 39,218 UTI panels, 11,923 cultures were performed. Postintervention urine cultures decreased by 2.09 per 1,000 patient days (PD) ( P <.05), with a significant postintervention downward trend of 0.15 cultures per 1,000 PD per month ( P <.05). Special indication designation decreased immediately by 2.17 special indications per 1,000 PD ( P <.05) with a reversal of the preintervention upward trend ( P <.05). Designation for neutropenia increased by 0.74 indications per 1,000 PD immediately postintervention ( P <.05); renal/pancreas transplant and pregnancy indications remained stable or declined. No compensatory increase in total urine cultures was observed. Conclusions: Removing the “other” free text option in a UTI panel led to a sustained reduction in overall urine culture ordering and low-value special indication designations. Modifying electronic order set architecture represents a feasible diagnostic stewardship strategy to reduce unnecessary testing and potential overtreatment of asymptomatic bacteriuria while preserving pathways for high-risk populations.