Becker's Hospital Review

98 CMO / CARE DELIVERY How Barnes-Jewish Hospital cut unnecessary UTI testing in half By Mackenzie Bean A simple change to St. Louis-based Barnes-Jewish Hospital's electronic ordering system helped cut the number of unnecessary urine culture tests ordered for suspected urinary tract infections nearly in half, according to a study published Feb. 21 in Infection Control and Hospital Epidemiology. For the study, researchers from the Washington Univer- sity School of Medicine in St. Louis implemented several interventions to reduce unnecessary testing for UTIs. In an email to Barnes-Jewish Hospital staff, the researchers encouraged the use of a urine dipstick test to identify signs of infection before ordering a bacterial culture test. Researchers also modified the hospital's electronic ordering system to include the use of a urine dipstick test as a default before a culture test. In the 15 months before the intervention's implementation, physicians ordered 15,746 urine cultures. In the 15 months after, physicians ordered just 8,823 cultures, which marks a 45 percent decrease and translates to $104,000 in saved laboratory costs. "Over-testing for UTIs drives up healthcare costs and leads to unnecessary antibiotic use, which spreads an- tibiotic resistance," senior author David Warren, MD, an infectious disease specialist and professor of medicine at Washington University, said in a news release. "We were able to reduce the number of tests ordered sub- stantially without diminishing the quality of care at all, and at a substantial cost savings." n US physician burnout drops below 50% for first time since 2011, study finds By Alyssa Rege U .S. physician burnout has dropped below 50 percent for the first time since 2011, according to a recent joint study by the American Medical Association, Stanford (Calif.) University School of Medicine and the Rochester, Minn.-based Mayo Clinic. More than 5,000 physicians responded to a survey conducted by researchers from the three institutions. Researchers found 43.9 percent of U.S. physicians exhibited at least one symp- tom of burnout in 2017, compared to 45.5 percent in 2011. Survey respondents also identified a higher level of work- life balance in 2017 (42.7 percent) than in 2014 (40.9 per- cent). The 2017 percentage was still less than levels in 2011 (48.7 percent). After adjusting for age, gender, hours worked in a week and other factors, physicians still remained at an increased risk for burnout and depression, researchers found. The study, published in Mayo Clinic Proceedings, noted that over- all levels of burnout have remained consistent around 28 percent since 2011. "The progress demonstrated in today's research suggests that growing national efforts to address physician burnout are on the right track, but more work is needed to achieve meaningful change. Addressing the crisis requires continued investment from the health system in a comprehensive strategy that tar- gets barriers to efficiently providing patients with high-quality care as the primary driver of physician burnout," AMA President Barbara McAneny, MD, said in a statement. n North Carolina hospital launches program to help malnourished patients after discharge By Megan Knowles W ilmington, N.C.-based New Ha- nover Regional Medical Center im- plemented a program to help mal- nourished patients aer they leave the hospital. e initiative aims to provide nutrition to malnourished patients who have limited ac- cess to food. When a registered dietitian at the hospital diagnoses a patient with malnu- trition, nutrition interventions are initiated to meet the patient's medical nutrition needs. Patients are discharged with instructions on how to properly nourish themselves to main- tain or rebuild strength and lean muscle mass. "We identified a gap in nutrition care once our patients were discharged," said Angela Lago, the hospital's manager of clinical nu- trition. "Aer our malnourished patients le the hospital, we didn't know if they had access to nutritious food, if family was able to help them obtain or prepare meals, if they were able to retain and implement the nutrition education they received, or if they were fol- lowing the nutrition care plan that was creat- ed specifically to help them heal." e hospital's malnutrition initiative includes a discharge nutrition food box to help food insecure patients continue their recovery. e facility's nutrition services team selects items for the food boxes, which include peanut but- ter, lean protein, granola bars, whole wheat bread and fruit. e boxes are also designed to require little to no preparation, so patients with limited mobility and energy can easily prepare a meal or snack. "Nutrition is imperative for continued im- provement in overall health and wellness," Ms. Lago said. "We cannot expect our pa- tients to bounce back from a trauma, stroke, fall, surgery or any other medical condition if their nutrition is inadequate. Nutrition is connected to everything." n

• Cover