Urine Culture Screening?

[SMILLER]

What are the ways in which urine culture orders are screened? For some time, we have been going by the concept that we can cancel C&S orders with a "screen negative" comment if the UA shows no evidence of a UTI.

In practice, our protocol is way too complicated. We have so many exceptions that it generates far more work than we save by cancelling the few C&Ss based on the protocol.

If a UA is not ordered at the same time, and recent UA results are not available, we order one ourselves. If the nitrite and esterase are negative, we have to look at the microscopic for WBCs or bacteria/yeast.

We do not screen outpatient UAs, just those collected in our hospital. We do not screen prenatals or pediatrics either.

I would be interested in any other facilities experience with screening urine C&Ss by using a UA. Thanks.

[AFiddler]

Good question. I like to refer to CMS's Lab NCD 23. Item 190.12 discusses Urine cultures. It calls out the 4 hot dipstick items (Leukocyte esterase, blood, nitrites and protein) plus microscopic findings of WBC, RBC and/or bacteria that may indicate that a culture is needed.

http://http://www.cms.gov/CoverageGenInfo/04_LabNCDs.asp

But, it also indicates that a patient's symptoms may also indicate a need for a urine culture.

To empower the physician to place orders that are "Reasonable and Medically Necessary", we built three different test groups in Meditech 6.0.

1. Urinalysis (dip and micro if indicated) the doctor would need to specifically add a culture.

2. UA w Culture if Indicated (CIF) (Reflex policy needed)

3. UA and culture

The Executive Medical Committee at your hospital would need to define the reflex lab test policy, review once a year and get sign-off from medical staff that they understand the policy.(Per Office of Inspector General policy)

Finally, consider that with the advent of ARRA, CMS can withhold payment if they think a UTI was obtained while in the hospital.

Your lab director, lab teams and hospital quality assurance team need to have a conversation about whether to error on the side of caution to perform a few more cultures than needed.....as opposed to not getting paid for a DRG. Yikes.

[Nancy L.]

We do the same as AFiddler. For our UA w Culture if Indicated, a culture is reflexed by the system if there are positive dipstick results of leukocyte esterase, blood, nitrates or proteins and microscopic findings of >5 wbc's per hpf or WBC clumps. The culture will not reflex if there are >2+ squamous epithelial cells. In that case, a comment is resulted that the specimen is not appropriate for culture as >2+ squamous epithelial cells is indicative of contamination. A new clean catch or cath specimen is requested if a culture is desired.

[macarton]

We do the same, offer a urine protocol. If the UA has mod to large epi's, a new UA is ordered and the culture rejected on the first specimen even if the WBC, Nit, bacteria pos. It took a while to work that out in Meditech.

[kriti]

We have meditech. Our UA is a hematology test.  Our urine culture is a micro test.  Does anyone have any suggestions about getting the culture to reflex across the different modules? Thanks.

[SMILLER]

This is an old topic, and I have to say that our protocol has been greatly simplified since it started.

 

Now we have three different tests relating to UAs and urine cultures.  A regular UA, a culture, and a UA/culture screen. 

 

The only time we screen for a culture is when the UA/culture screen is ordered.  This order, when it comes over from the HIS to the LIS, produces both a urine culture order and a UA.  If the UA is negative for a UTI, we cancel the culture with a "void per protocol" comment.

 

Scott