PT  - JOURNAL ARTICLE
AU  - Arjun Singh Ghuman
AU  - Pamela Mathura
AU  - Jaime C Yu
TI  - Stopping routine urine screening studies for stroke rehabilitation inpatient admissions
AID  - 10.1136/bmjoq-2022-002052
DP  - 2022 Nov 01
TA  - BMJ Open Quality
PG  - e002052
VI  - 11
IP  - 4
4099  - http://bmjopenquality.bmj.com/content/11/4/e002052.short
4100  - http://bmjopenquality.bmj.com/content/11/4/e002052.full
SO  - BMJ Open Qual2022 Nov 01; 11
AB  - Urine testing on asymptomatic patients is not aligned with guidelines; however, stroke survivors have trouble communicating symptoms, and urinary tract infections (UTIs) are a recognised poststroke complication. All stroke inpatients at a tertiary rehabilitation hospital underwent urine testing on admission. We led a quality improvement (QI) project on one stroke rehabilitation unit aimed to reduce admission urine testing from 100% to 0%. Baseline audit representing 2 weeks of admissions identified 27 of 28 patients had urine tests; however, none required UTI treatment despite 3 positive culture results. Estimated cost of testing was $C675. QI tools identified that a standardised paper-based admission form facilitated automatic urine testing. Project intervention strategies included education, clinicians crossing off urine orders and unit clerks flagging unaddressed orders for reassessment. A chart audit after 4 weeks and prescriber survey after 6 months assessed impact. Postintervention audit (n=23) revealed 1 patient had admission urine tests, 22 orders were crossed out, 1 chart was flagged and estimated testing cost declined from $C675 to $C25. Six urine tests were completed after admission and two patients required UTI treatment. Post 6 months, unit clerks assumed the role to cross out the order on the standardised form, and no patient had routine admission urine testing. There was no clinical benefit in screening for UTIs prior to stroke rehabilitation. This project is a practical example of deadopting a practice promoted by standardised order forms.Data are available upon reasonable request.