Stop routine microscopic urinalysis in hospitalized patients with dipstick abnormalities?
cessation
dipstick
internal medicine
microscopic
reflex
urinalysis
Journal
Journal of evaluation in clinical practice
ISSN: 1365-2753
Titre abrégé: J Eval Clin Pract
Pays: England
ID NLM: 9609066
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
revised:
04
11
2021
received:
12
09
2021
accepted:
08
11
2021
pubmed:
24
11
2021
medline:
22
7
2022
entrez:
23
11
2021
Statut:
ppublish
Résumé
Restricting the performance of microscopic urinalyses only to patients in whom it was specifically requested has been shown to reduce their number in laboratories servicing both inpatients and outpatients. To determine the effect of such restriction solely in in-patients in a 400-bed regional hospital. In 2017, we discontinued routine ('reflex') microscopic urinalysis for all positive dipstick results, and restricted such testing to in-patients in whom it was specifically requested by a doctor. We compared the numbers of patients in three internal medicine departments who had a urinalysis over 2-year periods before and after 2017, and reviewed doctors' complaints. Before 2017, more than 80% of all dipstick tested samples had one or more abnormalities that led to a microscopic examination. Discontinuation of reflex microscopy reduced microscopic urinalysis to less than 10% of all patients with dipsticks on admission. Requests for repeat urinalysis decreased from 4.3% to 2.5% and there were no complaints after the change in policy. Discontinuation of a 'reflex' microscopic urinalysis in patients with abnormal dipstick results did not increase repeat urine testing. Doctors apparently felt that the microscopic urinalysis does not have clinical utility in the vast majority of hospitalized adult patients.
Sections du résumé
BACKGROUND
Restricting the performance of microscopic urinalyses only to patients in whom it was specifically requested has been shown to reduce their number in laboratories servicing both inpatients and outpatients.
OBJECTIVE
To determine the effect of such restriction solely in in-patients in a 400-bed regional hospital.
METHODS
In 2017, we discontinued routine ('reflex') microscopic urinalysis for all positive dipstick results, and restricted such testing to in-patients in whom it was specifically requested by a doctor. We compared the numbers of patients in three internal medicine departments who had a urinalysis over 2-year periods before and after 2017, and reviewed doctors' complaints.
RESULTS
Before 2017, more than 80% of all dipstick tested samples had one or more abnormalities that led to a microscopic examination. Discontinuation of reflex microscopy reduced microscopic urinalysis to less than 10% of all patients with dipsticks on admission. Requests for repeat urinalysis decreased from 4.3% to 2.5% and there were no complaints after the change in policy.
CONCLUSIONS
Discontinuation of a 'reflex' microscopic urinalysis in patients with abnormal dipstick results did not increase repeat urine testing. Doctors apparently felt that the microscopic urinalysis does not have clinical utility in the vast majority of hospitalized adult patients.
Substances chimiques
Reagent Strips
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
566-568Informations de copyright
© 2021 John Wiley & Sons Ltd.
Références
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Froom P, Bieganiec B, Ehrenrich Z, Barak M. Stability of common analytes in urine refrigerated for 24 h before automated analysis by test strips. Clin Chem. 2000;46:1384-1386.
Shimoni Z, Glick J, Hermush V, Froom P. Sensitivity of the dipstick in detecting bacteremic urinary tract infections in elderly hospitalized patients. PLoS One. 2017;12:12. doi:10.1371/journal.pone.0187381