Modification of nursing-initiated standing order sets results in a non-significant decline in inappropriate urinalyses in an adult emergency department.

Inappropriate treatment of asymptomatic bacteriuria with antimicrobials is widespread in healthcare facilities and promotes antibiotic resistance. We assessed the degree urinalysis is ordered in absence of urinary symptoms. We randomly sampled 97 unique patients with urinalyses obtained in the Emergency Department in 2022 and reviewed their charts to determine if urinalyses were ordered according to society guideline-based indications. To identify risk factors for inappropriate ordering, we performed simple logistic regression between patients with inappropriately vs appropriately obtained urinalysis by various demographic factors. Following an intervention where nursing order sets were modified to reflect appropriate urinalysis usage, we reassessed the appropriateness of urinalyses in a sample of 95 unique patients within six months post-intervention. Pre-intervention, 65% (95% CI, 54.1-74.5%) of patients had inappropriately ordered urinalyses. Post-intervention, we noted a non-significant decrease to 52% (42.0-62.4%; χ2=2.8, p=0.095) of inappropriately ordered urinalyses. Post-intervention, Hispanic ethnicity was negatively associated with inappropriately obtained urinalyses (OR 0.30; 0.12-0.71). Most urinalyses remained inappropriately ordered despite a change in nursing order sets. Our results suggest provider-patient interactions are the major driver of inappropriately obtained urinalyses. The negative association with inappropriately obtained urinalyses in Hispanics suggests acuity of disease may influence this interaction.