4 minute read
How a UTI Triage System delivered improved patient care and cost savings at The Highlight Park Practice in Barry
By Forte Medical
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66% reduction in lab spend
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Specimen contamination reduced to 0%
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Reduced retests, repeat GP appointments and prescribing
Urine collection is one of the most common yet overlooked processes in Primary Care. Even though it’s a waste product, urine can be a window to our health if a reliable and accurate midstream sample is collected for routine analysis.
Working with Cardiff and Vale PCIC Board (The Primary, Community and Intermediate Care Clinical Board) and the staff and patients at Highlight Park Practice in Barry, we introduced a UTI triage programme to provide improved health outcomes and diagnose patient illness first time.
Heather Crowley, the prescribing lead at Highlight Park, describes the positive impact of introducing the UTI triage: “Using the Peezy device in clinical practice has allowed us to completely transform how we approach caring for patients presenting with UTI symptoms. Care is now streamlined, avoiding the need for repeat samples and avoiding mixed
Untreated Urinary Tract Infection
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Most common cause of unplanned hospital admissions, especially in the elderly
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47 per cent of blood infections that can lead to Sepsis have a urinary cause
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50 per cent of the global rise of AMR has urinary cause
growth culture results; meaning antibiotic prescriptions are far more appropriate. As a surgery it has allowed us to empower the non-clinical team to provide patients with clear and concise information at their first point of contact with the surgery. From a clinical perspective we have seen the number of prescriptions for antibiotics reduce as well as the number of mixed growth culture results. We are able to get the best outcomes for our patients in the quickest and safest manner.”
All guidelines call for clean-catch or midstream urine to be analysed for culture, whether for a urinary tract infection (UTI), dipped antenatal urines or even some STI tests. To capture this elusive sample, the patient must be instructed to start then stop the urine stream, position a cup or tube near the urethra … and start again.
Clean-catch/midstream is the holy grail because the first flush of urine can wash bacteria and natural flora from the labia into the sample, creating a mixed growth. These samples, often described as “contaminated”, can make analysis inaccurate, leading to unreliable diagnosis and treatment. This in turn might create over-prescribing of antibiotics, repeat tests, high rates of false-positive dipped urines and the development of chronic conditions that are far more difficult, long term and expensive to treat – not to mention debilitating for the patient.
The result of the tricky balancing act required to capture midstream is that many don’t bother but simply pee into a cup, collecting all and sundry within the sample. We know this because a Freedom of Information Request to all UK Trusts in 2016 showed national contamination rates that ranged from below 1 per cent to over 70 per cent. The average is 20 per cent, with one in five women too many keeping their legs crossed following untreated UTI.
From a practical perspective, asking a lab to analyse a contaminated sample is about as reliable as asking a detective to identify a crime through a dirty window. Yet with no guaranteed way of collecting midstream, this is exactly what is happening in Primary Care every day not only in Wales, not only in the UK, but throughout the world.
Thanks to the professional interest of the Infection Control leadership at Cardiff and Vale PCIC Board, patients in Wales are about to find it easier to provide midstream urine for their routine tests and receive more targeted treatment with fewer repeat appointments. Better still, their hands will remain clean and dry – a point of hygiene never more in the news than now.
Designed by Dr Vincent Forte, NHG GP and medical author, Peezy Midstream is a simple but highly engineered MedTech innovation conceived when he noticed a high number of women returning to his surgery with UTI after he had already treated the infection with antibiotics. Vincent’s investigations took him to the lab, where the practical problems surrounding unreliable urine samples were laid bare. The Peezy Midstream you see today was developed with patients and nurses, whose input resulted in three design iterations and a growing body of clinical evidence.
Thanks to the Cardiff and Vale PCIC Board, the screening of UTI patients and pregnant women in Wales is about to become more reliable, accurate, hygienic and dignified. With reduced antibiotic prescribing, they may also be less exposed to the risks of antibiotic resistance, a condition fueled by over-use of dipped urines combined with the broad-spectrum antibiotics so commonly relied upon in place of urine culture, in Primary Care.
