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Optimizing Urinalysis Utilization in Hospital Admissions: A Business in Medicine Project

This presentation by Ani Baghdassarian, MD, discusses a chart review on 15 patients admitted to LBVA, focusing on urinalysis utilization. Findings reveal inappropriate UA orders on admission, insignificant repeat UA results, and cost implications. Recommendations include better UA indication assessment to enhance cost-effectiveness.

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Optimizing Urinalysis Utilization in Hospital Admissions: A Business in Medicine Project

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  1. Business in Medicine Project Presentation AniBaghdassarian, MD

  2. BUSINESS IN MEDICINE • Chart review performed on 15 patients admitted to the LBVA, specifically S8. • Test chosen was urinalysis • Patients were reviewed to see if and when a UA was obtained and repeated.

  3. BUSINESS IN MEDICINE • Of the 15 patients reviewed, 11 of the patients had a urinalysis ordered during their hospitalization. • 8 of those patients had a UA ordered on admission, 5 of whom never had another UA done. • Of the other 3 of the 11 patients, one had a UA prior to admission and then multiple other times throughout and the other 2 had a couple ordered during their hospital stay but not on admission.

  4. BUSINESS IN MEDICINE • Of the patients (8) who had the UA on admission, their reasons for admission: - 1 pt had frequent falls, found to have UTI - 1 came with memory loss, gait disturbance, and urinary incontinence- diagnosed with NPH. - 1 presented with shortness of breath and found to have a pleural effusion. - 3 were admitted for skin conditions: 2 for cellulitis and one for diabetic ulcer - 1 was admitted for chemotherapy, to be started on Cisplatin. - 1 was admitted for shortness of breath and treated for HCAP.

  5. BUSINESS IN MEDICINE • In the repeated UA group (6/15), they were either done for AMS, fever, dysuria, on chemotherapy, and one was unexplained (couldn’t find indication in documentation). • In any of the subsequent UAs that were ordered, only one came back positive for infection (what the test was originally ordered to look for). The positive UA was found in a surgical patient admitted s/p a nephroureterectomy, requiring a hospital stay of many months.

  6. BUSINESS IN MEDICINE

  7. CONCLUSIONS • In reviewing information online, cost of a UA can run from $6-20. • The majority of patients who had a UA obtained at admission really weren’t warranted for their reason for admission (to note, 7/8 were originally ordered by the ED). • Those who subsequently had repeat UAs done didn’t reveal any new information or alter management from that standpoint (except for the one surgical patient- restarted on antibiotics).

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