Improving urine culture appropriateness and reducing unnecessary testing through education and feedback in a hospital setting.

OBJECTIVE: To evaluate the impact of an educational intervention on the appropriateness of urine culture indications and overall urine culture trends. METHODS: A quasi-experimental study in six medical wards of an acute care hospital included a pre-intervention phase (Jan 2019-Dec 2021) and an intervention phase (Jan 2022-Dec 2023). The intervention comprised educational sessions, best practice guidelines, and feedback. Urine culture appropriateness was assessed by reviewing a sample of 360 records from both periods. Bivariate and multivariable logistic regression identified predictors of appropriate urine cultures, and time-series analysis assessed trends in culture rates. RESULTS: The median age of patients was 81 years (IQR 70.1-87.0), with no differences between the two periods in age, sex, residence in long-term care, or comorbidities. The appropriateness of urine cultures increased significantly from 43.9% (79 of 180 patients) in the pre-intervention period to 56.7% (102 of 180 patients) in the post-intervention period (p = 0.015). The intervention period (OR 1.66; 95% CI, 1.07-2.57; p = 0.023) and younger age (OR, 0.97; 95% CI, 0.95-0.99; p < 0.001) were significantly associated with improved appropriateness. Urine culture rates showed no significant pre-intervention trends (p = 0.19) but decreased by 18% post-intervention (p < 0.001). CONCLUSIONS: Younger age and the intervention period were associated with reduced unnecessary urine cultures and improved adherence to appropriate practices. These findings highlight the importance of ongoing educational initiatives and feedback in enhancing diagnostic stewardship.