Asymptomatic Bacteriuria, Urinary Tract Infection
Conditions
Keywords
antibiotic stewardship, kicking cauti
Brief summary
This is a randomized study to evaluate the effectiveness and implementation of an intervention to decrease unnecessary urine testing for surgical patients (Less is More for Surgical Urine Testing) across six geographically diverse Veterans Affairs Medical Centers. The intervention will unfold over two years, in three phases: control, intervention, and sustainability.
Detailed description
The purpose of this study is to implement our surgery-tailored evidence based 'Kicking CAUTI' intervention package in diverse surgical settings across the Veterans Affairs Medical Centers (VAMCs), and assess its effectiveness at de-implementing low-value perioperative urine testing and related inappropriate antibiotic prescribing. In this hybrid type 2 effectiveness-implementation study, the investigators will conduct a stepped wedge cluster randomized trial to evaluate the effectiveness, implementation, and cost of the tailored intervention at up to six VAMCs.
Interventions
BEHAVIORALInterventional Project Site Visit
Activities occurring during the 12-month intervention phase * 1:1 meetings introducing the project * Site Visit (once during intervention period) * Interactive teaching cases and didactic sessions * Distribution of algorithm as pocket cards * Access to project materials on SharePoint * Feedback reports on clinical outcomes * Evidence-based order set templates * Learning collaborative webinars * Individualized coaching
Sponsors
VA Office of Research and Development
Study design
Allocation
RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Masking description
This study is a hybrid type 2 effectiveness/implementation study with a dual focus on clinical effectiveness and implementation outcomes using a stepped wedge cluster randomized trial among six recruited VAMCs.
Intervention model description
Stepped Wedge Cluster Randomized Trial
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Medical Centers part of the Veterans Affairs Health Administration (VAMCs) * VAMCs that perform standard, intermediate, or advanced surgical procedures * VAMCs in which perioperative urine testing is performed among greater than 10% of their non-urologic, non-transplant surgery procedures
Exclusion criteria
* VAMCs that only perform ambulatory surgery (outpatient/day surgery only) * VAMCs that do not perform urine testing among at least 10% of their non-urologic, non-transplant surgery procedures * VAMCs that already have implemented interventions to reduce perioperative urine testing * VAMCs' units performing genitourinary or transplant surgeries * Database of patients with a diagnosis of urinary tract infection within 30 days before surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number of Urine Testing Performed | up to 48 months | Throughout the study period, the research team will generate monthly lists of all urinalyses and urine cultures performed within 30 days before and 30 days after included procedures. The study team will chart review theses cases and determine whether the urine test was done on an asymptomatic patient or whether the test was justified based on UTI symptoms. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Days of Therapy | up to 48 months | Days of therapy is an aggregate sum of days on which an antimicrobial agent was administered to an individual patient. The investigators will include systemic antibacterial agents administered within 30 days before and 30 days after surgery. The investigators will exclude doses given as standard preoperative prophylaxis and antimicrobial agents that are not used for urinary tract infections. |
| Budget Impact Analysis | up to 48 months | Time spent by sites will be converted into cost by multiplying the hourly wage rate plus benefits for each type of healthcare professional involved in the intervention |
Countries
United States
Contacts
CONTACTMarin L Schweizer-Looby, PhD BS
PRINCIPAL_INVESTIGATORMarin L. Schweizer-Looby, PhD BS
William S. Middleton Memorial Veterans Hospital, Madison, WI
Outcome results
None listed