The Impact of De-implementing Urine Dipsticks for Diagnosis of UTIs in Hospitals

Condition(s) studied

Investigational drug(s) / intervention(s)

De-implementation of Urinary Dipsticks: In August 2023 / February 2024, urinary dipsticks were de-implemented in hospitals across the North Denmark Region. Using registry-based data, the investigators aim to evaluate the clinical impact of this decision.

Usual practice with no intervention: In hospitals within the Central Denmark Region and in the primary care sector, urinary dipsticks have not been de-implemented and remain in use. Registry-based data from these settings will serve as a control.

Study summary

The goal of this interrupted time-series analysis is to evaluate the impact of the de-implementation of urine dipsticks as a diagnostic tool for urinary tract infections (UTIs) in hospitalized patients in the North Denmark Region. The main question it aims to answer is:

How does de-implementation of urine dipsticks affect the diagnosis and management of UTIs and related disorders?

Specifically, does it change the following parameters:

* Number and severity of UTI infections (lower and upper UTI, non-severe and severe)
* Antibiotic prescription (overall, antibiotic classes, administration routes, duration, dosages)
* Number of urine cultures and number of positive urine cultures
* Risks of admission to intensive care units and 30-day mortality
* Risk of drug toxicity
* Length of hospital stay
* Risk of admission to intensive care unit
* 30-day risk of readmission after discharge
* 6-month risks of Clostridioides difficile enterocolitis and de novo antimicrobial resistance in cultures obtained during routine clinical care.

Researchers hypothesize that de-implementing urine dipsticks will lead to a reduced frequency of diagnosed cystitis, reduced antibiotic use, and fewer urine cultures without negatively affecting patient mortality or readmission risk.

Researchers will compare the outcomes before and after the discontinuation of urine dipsticks across hospitals in the North Denmark Region. Furthermore, results will be compared to another Danish administrative healthcare region where dipsticks are still in use as well as urine culture data from the primary sector in the North Denmark Region.

Since this is a registry-based observational study utilizing data from the electronic patient record system in the North Denmark Region, no direct contact will be made with participants.

Eligibility

Primary outcome measure(s)

• Monthly Incidence Rate of Urinary Tract Diagnoses (Composite Measure) — The monthly incidence will be calculated between January 2019 to end of the study (September 2025)
  The monthly count of urinary tract infection diagnoses (ICD-10 codes: DN300, DN308C, DN309, DA419B) will be divided by the total person-time contributed by all admitted patients to the hospitals. The resulting incidence rate will be expressed as the number of cases per 1000 patient-days.
• Monthly Incidence Rate of Urine Cultures (Composite Measure) — The monthly incidence will be calculated between January 2019 to end of the study period (September 2025)
  The monthly count of urine cultures (including all cultures, both positive and negative) will be divided by the total person-time contributed by admitted patients. The resulting incidence rate will be expressed as the number of cases per 1000 patient-days.
• Monthly Incidence Rate of Antibiotic Usage (Composite Measure) — The monthly incidence rate will be calculated between January 2019 to end of the study period (September 2025)
  The monthly count of urinary tract infection-specific antibiotic use (pivmecillinam, nitrofurantoin, sulfamethizole, and trimethoprim) will be divided by the total person-time contributed by all admitted patients to the hospitals. The resulting incidence rate will be expressed as the number of cases per 1000 patient-days.
• Monthly Mortality Rate (Composite Measure) — The monthly mortality rate will be calculated between January 2019 to end of the study period (September 2025)
  The monthly count of deaths will be divided by the total person-time contributed by admitted patients. The resulting mortality rate will be expressed as the number of deaths per 1000 patient-days.
• Monthly Incidence Rate of Readmissions (Composite Measure) — The monthly incidence rate of readmissions will be calculated between January 2019 and the end of the study period (September 2025)
  The monthly count of readmissions, defined as a return to an inpatient unit or emergency room within 30 days after the initial discharge, will be divided by the total person-time contributed by admitted patients. The resulting incidence rate will be expressed as the number of readmissions per 1000 patient-days.
• Median Length of Hospital Stay — The monthly median will be calculated from January 2019 to the end of the study period (September 2025).
  The length of hospital stay will be measured in days for each admitted patient. The monthly median and interquartile range will be calculated over the study period.

Trial sites (2)

Other trials for the same condition