Evaluating the diagnostic cycle for factors impacting urine culture reporting: A quasi-experimental quality improvement study
Bergin C, Suchitra Shenoy, Udayalaxmi Jeppu, Pooja RaoBackground
Urine culture is a frequently performed microbiological test and is essential for diagnosing urinary tract infection. This study evaluated the urine-culture diagnostic cycle, identified process gaps, and assessed changes after a targeted quality-improvement intervention.
Methods
A quasi-experimental before-and-after quality-improvement study was conducted in two tertiary-care hospitals in South India. The pre-intervention assessment included 708 inpatient urine specimens collected during October-November 2025. Staff training, feedback, and process review were undertaken during December 2025-January 2026, followed by assessment of 251 specimens during February-March 2026. The assessment included specimen documentation and transport, processing turnaround time, microscopy-culture correlation, culture interpretation, reporting completeness, and follow-up of mixed growth.
Results
Complete clinical and antibiotic-treatment documentation increased from 21/708 (3.0%) to 12/251 (4.8%; absolute increase, 1.8 percentage points; p=0.175). The proportion of specimens processed within two hours of receipt increased from 532/708 (75%) to 218/251 (87%; p<0.001). Specimens with pus cells and significant culture growth increased from 86/708 (12.1%) to 76/251 (30.3%; p<0.001). Repeat cultures obtained after an initial mixed-growth report yielded significant growth in 7/11 pre-intervention and 5/8 post-intervention specimens (p=1.000).
Conclusions
After the quality-improvement process bundle, adherence to the two-hour processing target and microscopy-culture concordance improved, whereas clinical documentation remained poor. Because this uncontrolled before-and-after study is vulnerable to seasonal and case-mix differences, the changes represent associations and cannot be attributed solely to the intervention. Continued audit, staff training and awareness are warranted.