title: Utility of routine urinalysis and urine culture testing in an ambulatory urology clinic: a quality improvement initiative in a Veterans healthcare facility.
abstract: BACKGROUND
  Urinalysis (UA) and urine culture (UCx) are commonly performed tests in the urology clinic. Many of these urine studies are performed prior to the patient visit may not always be indicated, thus contributing to unintended consequences such as antibiotic use and costs without enhancing patient care. Our objective was to perform a quality improvement initiative aimed to assess the utility of routine UA/UCx.
  
  
  METHODS
  The practice pattern at our site's Veteran Affairs (VA) urology clinic prior to 2014 was to obtain routine UA/UCx on most clinic visits prior to patient evaluation. Starting in 2014, we designed an intervention whereby our nurse practitioner triaged all new patient referrals and selectively ordered UA/UCx. We performed multivariable logistic regression to assess for predictors of obtaining UA or UCx.
  
  
  RESULTS
  A total of 1308 patients were seen in January-March 2013 and 1456 in June-August 2014 and were included in this analysis. Fewer patients in 2014 received UA (59.8% versus 70.0%, p < 0.001) and UCx (49.6% versus 64.2%, p < 0.001). There was a decreased odds of obtaining UA in 2014 (OR 0.52, p < 0.001) as well as a decreased odds of obtaining UCx in 2014 (OR0.38, p < 0.001) on multivariable logistic regression. The results of UA/UCx only rarely resulted in change of management in either cohort (3%). Selective ordering resulted in an estimated cost savings of $4915.08/month in UCx costs alone.
  
  
  CONCLUSIONS
  Our quality improvement initiatives reduced rates of UA/UCx testing when providers assess patients prior to ordering these tests. The implication of this initiative is significant cost savings for the healthcare system.
authors.affiliation: Department of Urology, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA.
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Richards
authors.forename: Stacy
authors.initials: S
authors.lastname: Cesario
authors.forename: Amy H
authors.initials: AH
authors.lastname: Lim
authors.forename: Sara L
authors.initials: SL
authors.lastname: Best
authors.forename: Susan M
authors.initials: SM
authors.lastname: Deeren
authors.forename: Wade
authors.initials: W
authors.lastname: Bushman
authors.forename: Nasia
authors.initials: N
authors.lastname: Safdar
mesh_terms: D000368:Aged; D017046:Cost Savings; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D065186:Interrupted Time Series Analysis; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D058996:Quality Improvement; D014218:Triage; D016482:Urinalysis / Q000191:economics / Q000706:statistics & numerical data*; D014556:Urine / Q000382:microbiology; D014572:Urology / Q000592:standards / Q000706:statistics & numerical data*; D014922:Wisconsin