De-implementing PreOp Urine Testing

VA Office of Research and Development

Status: Begins enrollment in 9 months

Conditions: Asymptomatic Bacteriuria; Urinary Tract Infection

Treatments: Behavioral: Interventional Project Site Visit

Study type: Interventional

Funder types: Other U.S. Federal agency

Identifiers

NCT07411209

I01RD000425-01A2 (Other Grant/Funding Number)

HSR5-024-24W

Details and patient eligibility

About

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.

Full 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.

Enrollment: 6 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

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

Trial design

Primary purpose: Health Services Research

Allocation: Randomized

Interventional model: Sequential Assignment

Masking: None (Open label)

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6 participants in 2 patient groups

Intervention Site Visit

Experimental group

Description:

VAMCs randomized in this arm will receive full access to our resources library, will receive invites to our monthly meetings, receive monthly feedback on clinical outcomes, access to project materials, etc.

Treatment:

Behavioral: Interventional Project Site Visit

Standard of Care

No Intervention group

Description:

VAMCs randomized to the standard arm will proceed with normal standard of care