The 2-step urine collection (UC) process was implemented in the Emergency Department (ED) at Michael Garron Hospital in 2014. When a patient comes into the Emergency Department and provides a urine sample it is placed into a special collection container with a preservative allowing the sample to be stored at room temperature for up to 48 hours.
After collection the urine culture sample gets sent directly to the laboratory where a urinalysis is completed, and samples are labeled for the day they were collected before being organized in wired racks. Once a clinical assessment had been completed by the ED Physician and only after they believed a urine culture was required would they put in an order for “Step 2: Process Urine”. The laboratory would then proceed with processing the urine specimen for culture and susceptibility testing at the microbiology laboratory. All urine samples that exceed the 48 hour limit of storage in the lab without a request to be processed by the physician are discarded.
The goal of the project was to reduce unnecessary urine cultures. Through a reduction in unnecessary urine cultures we have reduced inappropriate antimicrobial use, decreased the need for patient callbacks for positive urine cultures and reduced the burden on hospital resources within the microbiology laboratory, reflected through positive cost savings.