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Change In Health Records System Leads Barnes-Jewish Hospital To Cut Thousands Of Tests

Dominic Alves | Flickr
By switching the order it conducted tests for urinary tract infections, Barnes-Jewish Hospital in St. Louis cut thousands of unnecessary bacterial cultures in patients.

Barnes-Jewish Hospital in St. Louis has cut testing for urinary tract infections nearly in half after making changes to its electronic health records system.

The hospital did so by making a simple switch: it changed the order in which it conducted tests for the infections. Physicians are now directed to order a dipstick urine test before a bacterial culture to test for an infection. The change cut the number of unnecessary tests by 45 percent. Barnes officials say that saved the hospital nearly $100,000 in lab costs and cut down on unnecessary antibiotic prescriptions.

The results show that changing how tests are ordered electronically can influence patient care, said David Warren, the hospital’s medical director for infection prevention.

“As we move to more of these electronic-medical-records health systems, the way they’re designed can really have a large impact on medical practice itself,” he said.

Health systems are increasingly reliant on electronic health records, which physicians use to look up patient history, make diagnoses and order tests.

Previously, the electronic system directed doctors to test patients for UTIs with a bacterial culture. However, that method often lead to false positives, since many people without infections already have bacteria in their urine.

“You may be deciding, ‘Do I need to treat with antibiotics or not?’ And that can lead to a dilemma, and that can lead to people using antibiotics in a situation where there actually isn’t an infection,” Warren said.

In 2016, Warren, a data analyst and other Barnes physicians instead directed doctors to first test with simple urine dipstick tests. That checks for inflammatory cells, not bacteria. If that dipstick test is positive, they order a bacterial culture.

Researchers from Washington University found the hospital ordered a total of 8,823 culture tests in the 15 months after the switch, compared with 15,746 tests before. Even with the drop, there wasn’t an increase in undiagnosed UTIs, Warren said.

That means fewer doctors prescribed unnecessary antibiotics for people without an infection. When doctors write too many prescriptions for antibiotics, that can lead to antibiotic resistance and make medicines less effective when patients do have an infection.

The $100,000 in reduced lab costs came over 15 months, Wash U officials said.

Hospitals increasingly are seeking ways to deliver improved outcomes at lower costs as they move away from fee-for-service payment models, which charge based on each procedure done, to bundled services and outcomes-based payments, which reimburse hospitals based on the health of patients.

Barnes-Jewish Hospitals across the region are adapting the new UTI testing practices, Warren said.

Follow Sarah on Twitter: @petit_smudge

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Sarah is the health reporter at St. Louis Public Radio.

Send questions and comments about this story to feedback@stlpublicradio.org.