Alternative strategies to provide actionable results when supply of urinalysis strips is unavailable

Abstract

Urinalysis “dip strips” offer physicians qualitative results of 6 analytes which are immediately actionable: protein, glucose, leukocyte esterase, nitrates, blood, and ketones; however, the strips are instrument specific such that they are at the mercy of supply chain shortages. Due to vendor supply issues, we implemented a strategy that would continue to support clinical decision making in the absence of supplies for protein, glucose, white blood cells (WBC) and blood (RBC) detection. Method: In supply shortage situations, an automated algorithm triggered such that urine samples would be sent to the automation chemistry line to run quantification of protein and glucose and make sure an automated urine microscopy was performed for RBC and WBC detection. The algorithm triggered printing two labels so nursing would collect two specimens. We monitored the turn-around time from the specimen being received in the laboratory to results, made sure that the culture reflex order was triggered, and tracked complaints by physicians regarding not having all usual urinalysis results provided by the strips. Prior to implementation, correlation between sample types for protein and glucose measurement was found acceptable.

RESULTS: When we put in place the algorithm, the turn-around time of urine microscopic study was identical to that obtained when the urinalysis was done with the strips; however, the quantification of glucose and protein took approximately 30 minutes more. Urine reflex cultures were triggered correctly with the algorithm as they derive entirely from a WBC count >20. During the period we had the algorithm in place we only had one complaint by a physician wanting to have results of nitrates.

Conclusion: The successful implementation of the algorithm allowed the laboratory to provide actionable urinalysis analytes in a timely manner with minimal complaints from physicians.