2026 Eastern States Conference

Authors
Allison Pollina PharmD, Maricelle Monteagudo-Chu PharmD, BCPS, BCIDP, Adam Wos MD, David Galinkin MPH, DO, Gregory Haggerty PhD, Tyler Yarema, PharmD

Background/Objective
To evaluate the impact of removing pre-checked urine culture orders from emergency department order sets on urine culture ordering, antibiotic prescribing, length of stay, and 30-day hospital readmissions or ED visits attributable to UTI.

Methods
Pre-checked urine culture orders were removed from 10 ED order sets in 3 phases between May 2024 and March 2025 (May 3, September 10, and March 27). This retrospective chart review included adult patients presenting to the ED during the pre-intervention (02/01/24 – 04/30/24) and post-intervention (04/01/25 – 06/30/25) periods who had urinalysis performed, including those admitted to the hospital. Patients were excluded if they were less than 18 years, had urinalysis ordered outside of the ED, or were treated with antibiotics for an indication other than a UTI. The primary endpoint was to assess the impact on the number of urine cultures ordered and performed, comparing 3 months before and after the intervention. Secondary endpoints included evaluating the influence on antibiotic prescribing patterns, such as initiation, selection, and duration, hospital length of stay for admitted patients, and readmission to the hospital or ED within 30 days from the initial encounter due to UTI.

Results
A total of 271 patient charts were reviewed, of which 200 patients (100 from both the pre- and post-intervention groups) met the inclusion criteria. Baseline characteristics were comparable between arms except for indications for urine culture ordering in the post-intervention phase. Analyses following the removal of pre-checked urine cultures from 10 ED order sets revealed a 38.8% and 27% reduction in the number of urine cultures ordered and performed, respectively. We observed no difference in the number of patients started on antibiotics for abnormal urinalysis or urine culture, a negligible decrease of 6% in average antibiotic treatment duration, and a 50% increase in average length of stay amongst admitted patients.

Conclusion(s)
The removal of pre-checked urine culture orders from ED order sets reduced the number of cultures ordered and performed without compromising patient safety. A more judicious approach to urine culture ordering was seen in the post-intervention phase. Although an increase in ED visits and hospital readmissions within 30 days due to UTI were observed in the post intervention period, they were not found to be statistically significant when compared to the pre-intervention.