Reduces Unnecessary Urine Culture Orders by 29% With MEDITECH’s Clinical Decision Support

lab worker checking sample

When The Joint Commission updated its 2023 Antibiotic Stewardship elements of performance, Senior Medical Infectious Disease Director David Byers, MD, and his team saw an opportunity to reduce antibiotic use and save resources with help from Southern Ohio Medical Center’s Expanse EHR.

“The Joint Commission required that we pick two conditions and prove we had made an impact on one of them,” said Dr. Byers. “We thought if we could leverage MEDITECH’s clinical decision support and analytics capabilities to decrease and monitor treatment of asymptomatic bacteriuria, we could meet all the conditions outlined in that new update.”

Leveraging Expanse to improve patient safety

SOMC worked with MEDITECH to create urine culture ordering screens and rule logic in Expanse that ensure patients meet the appropriate clinical criteria before clinicians place the order. By leveraging Expanse, the organization has been able to reduce unnecessary urine culture lab orders.

“It’s basically using the system to help people make smarter, better healthcare decisions that result in fewer adverse effects for patients,” said Dr. Byers.

Clinical Pharmacist Lara Ramey, PharmD, noted that SOMC’s clinical pharmacy team conducted prospective audits as part of its previous process. They consulted with physicians on antibiotic orders – especially when prescribed for urinary tract infections – to improve stewardship.

“Treating asymptomatic patients with antibiotics when they don’t need them could be detrimental and keeps them in the hospital longer,” said Ramey.

Collaborating for quality care

Previously, SOMC and MEDITECH partnered on a project to automate the medical center’s workflow for C. difficile testing, which led to a 30% relative change in hospital-acquired C. diff infections.

“The knowledge transfer that occurred during that project was key to our success on this one,” said Dr. Byers. “We had an idea, but the team at MEDITECH helped us take that idea and make it workable in a system that has had a significant impact.”

Confident in that knowledge, SOMC transitioned seamlessly to the new workflow, which was universally accepted among its care teams.

“With help from the MEDITECH analysts, we were able to get the fancy three-part question to appear on the ordering screen,” said Clinical Informatics Specialist Michael Eldridge, RN. “Depending on clinicians’ responses to those questions, decision support capabilities determine whether or not the patient meets the criteria and the urine culture order can be placed.”

Physicians have the ability to override the rule logic even if the patient does not meet the criteria, but other personnel – such as nurses – receive a hard stop.

Eldridge and his team kept staff informed through an SBAR communication brief and advised them to reach out to task force members if they had any questions, a testament to SOMC’s culture of transparency.

Measuring the results

Lead Clinical Information Systems Specialist Gerard Givan created the Business and Clinical Analytics dashboard to visualize metrics such as the number of cultures ordered, the clinicians who ordered the cultures, and the clinical criteria they selected.

“This is the key piece,” said Dr. Byers. “We talked about meeting Joint Commission requirements, but there’s also the expectation that we can prove an impact.”

“There's so much data here, and we can toggle through it very quickly to find information we need,” added Ramey.

Six months after implementation, SOMC reported a 29% decrease in urine culture orders in the acute setting. Eldridge and his team are currently fine-tuning the process on the ambulatory side.

“Our quality and safety leadership teams have been very excited about this initiative,” said Dr. Byers. “It’s a win for everyone.”