Many people seek help in emergency departments for urinary tract infections. However, studies have found that antibiotics are used incorrectly about 30-40% of the time. One reason for this is that urine cultures taken during the emergency department visit can take several days to process. If too many antibiotics are used when they are not needed, or not enough is given when needed, this can cause the bacteria in the local community to change and infections to become harder to treat with the usual antibiotics. They noticed that the follow-up on urinary tract infections treated at the emergency department could be improved.
In 2020, they started a new process where pharmacists reviewed all urine cultures from the emergency department that were processed as positive. They tracked whether changes were made to the antibiotics that were ordered and how long it took to make changes. Then they compared the old process with the new process. When pharmacists reviewed urine cultures, more appropriate changes were made to antibiotics. Pharmacists were able to follow-up about 1 day faster and patients took shorter courses of antibiotics, saving patients 64 days of antibiotics over a 2-month time frame. They were able to do this without causing patients to come back to the emergency department more often. Besides lowering the amount of antibiotics used for urinary tract infections, they also realized that part of the limitation was that the samples were often contaminated. This suggested that an improvement in the techniques for taking urine samples could help produce better samples. Thereafter, new signs with clear instructions were posted in the restrooms, and they created materials to help doctors in the emergency department pick the best antibiotic.