De-implementing PreOp Urine Testing

De-implementation of Unnecessary Pre-Operative Urine Testing

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.

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.

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