Reducing Urine Contamination in Emergency (RedUCE)

Aim

To reduce contamination rates in mid-stream urine samples by using posters and/or flyers to educate patients on correct collection technique.

Outcomes

Benefits:

• improved patient care by avoiding diagnostic delays
• cost and time savings through avoidance of repeat testing
• responsible and efficient use of pathology services

Background

Mid-stream urine is a frequently performed diagnostic test in emergency departments that relies on patients using correct collection technique to avoid sample contamination. Contamination rates are typically high (approximately 25 per cent across Queensland Health).

What is now known as RedUCE, was initially implemented at the Princess Alexandra Hospital (PAH) as a research trial led by Dr Robert Eley. The 2016 publication demonstrated a significant reduction in rates of urine sample contamination in the PAH Emergency Department (ED).

This initiative was introduced to PROV-ED by Clinical Research Nurse, Chantelle Judge, and Emergency Staff Specialist ,Dr Georgina Livesay from the PAH Emergency Department, Metro South Health.

Discussion

By providing patient leaflets and subsequently posters, clinical researchers at the PAH demonstrated a 15 per cent reduction in mid-stream urine contamination rates in the ED.

Evaluation of RedUCE under the PROV-ED Project will involve comparing pre- and post-implementation contamination rates of midstream urine from Pathology Queensland data.

Lessons learnt

• ED staff are time-poor and reliance on verbal instructions is ineffective
• Written interventions may not be suitable for many patients
• Simple illustrations are an effective option for providing clear and consistent instructions to patients
• Graphics used must strike a balance to include enough anatomical detail without being overly confronting (a small proportion of patients surveyed for the pilot implementation reported finding the original graphics confronting).

References

Illustrations reduce contamination of midstream urine samples in the emergency department. Journal of Clinical Pathology Published online first: 18 February 2016. Doi: 40.1136/jclinpath-2015-203504

Journal of Clinical Pathology