Comparison of 6499 patients who had any urine testing in the emergency department (ED) before and after intervention
| Study cohort* | Pre intervention (1 September to 20 October) | Post intervention (21 October to 30 November) | P value | |
| n=6499 | n=3711 | n=2788 | ||
| Patient characteristics | ||||
| Age, median (IQR) | 46 (30–62) | 46 (29–62) | 46 (30–62) | 0.88 |
| Race, n (%) | ||||
| White | 2499 (38.5) | 1453 (39.2) | 1046 (37.5) | Ref |
| Black | 3687 (56.7) | 2086 (56.2) | 1601 (57.4) | 0.22 |
| Other | 313 (4.8) | 172 (4.6) | 141 (5.1) | 0.28 |
| Sex, n (%) | ||||
| Male | 2441 (37.6) | 1406 (37.9) | 1035 (37.1) | 0.53 |
| Female | 4058 (62.4) | 2305 (62.1) | 1753 (62.9) | Ref |
| Discharge status, n (%) | ||||
| Admitted to hospital | 2916 (44.9) | 1625 (43.8) | 1291 (46.3) | 0.55 |
| Discharged to home from ED | 3314 (51.0) | 1931 (52.0) | 1383 (49.9) | 0.84 |
| Discharged to other facility/expired/AMA† | 269 (4.1) | 155 (4.2) | 114 (4.1) | Ref |
| Urine testing practices | ||||
| Urinalysis, n (per 1000 ED visits) | 6556 (285.7) | 3744 (291.5) | 2812 (278.4) | 0.03 |
| Leukocyte esterase positive, n (%) | 2553 (38.9) | 1428 (38.1) | 1125 (40.0) | 0.08 |
| Urine microscopy, n (per 1000 ED visits) | 4408 (192.1) | 2524 (196.5) | 1813 (179.5) | 0.001 |
| Urine microscopy result (WBC/hpf), n (%) | ||||
| ≤5 | 2540 (57.6) | 1500 (59.4) | 1040 (55.2) | Ref |
| >5–49 | 1209 (27.4) | 675 (26.8) | 534 (28.3) | 0.06 |
| ≥50 | 659 (15.0) | 349 (13.8) | 310 (16.5) | 0.005 |
| Urine cultures performed, n (per 1000 ED visits) | 997 (43.4) | 697 (54.3) | 300 (29.7) | <0.0001 |
| Positive culture, n (%) | 392 (39.3) | 270 (38.7) | 122 (40.7) | 0.43 |
| Catheterised cultures, n (per 1000 ED visits) | 49 (2.1) | 22 (1.7) | 27 (2.7) | 0.0002 |
| Isolated culture, n (%)‡ | 25 (2.5) | 16 (2.3) | 9 (3.0) | 0.51 |
*Patient visits to ED whose urine was tested (≥1) either for dipstick, microscopy or culture at ED during the study period. Overall 22 948 patients visited ED during 1 September to 30 November 2015, 12 846 during 1 September to 20 October (pre intervention) and 10 102 during 21 October to 30 November (post intervention).
†Other facility, 265; expired, 4; pre intervention: other facility, 152; expired, 3; post intervention: other facility, 113; expired, 1.
‡Isolated is defined as a urine culture performed without either a urinalysis or urine microscopy within 24 hours before or after the culture.
AMA, against medical advice; hpf, high-power field; WBC, white blood cells.