Quality improvement opportunities for urine culture follow-up in a tertiary care emergency department: A pilot study

Abstract

Institutional quality assurance processes have been developed to address the follow up of abnormal test results ordered in the emergency department (ED). We conducted a health records review at an academic tertiary care ED to understand the process and times taken to follow up post-discharge urine culture results transferred to physicians for review. All patients (age ≥18 years) who were seen and discharged between July 1, 2020 and June 30, 2021 and had a positive urine culture were eligible for inclusion. We randomly selected 100 patients, abstracted follow-up times, and reported descriptive statistics. 65 were initially identified as requiring further follow-up for their culture results. Nearly 80% of these patients required new, additional, or revised antimicrobial therapy. Overall, the mean time from ED discharge to follow-up completion was 3.4 days (SD 2.1 days). The longest contributor was the time for transfer of results from nurses to physicians for review at 1.4 days (SD 1.2 days). We demonstrated considerable delay in the follow-up of urine culture results requiring physician review. Future work should address opportunities for reducing times to follow-up, including semi-automation of benign culture results and capture of key patient demographic information in the electronic medical record.

Keywords

• quality improvement
• quality assurance
• urine culture
• emergency department