De-implementing PreOp Urine Testing

NCT07411209 — Not applicable, Not yet recruiting, 6 participants, VA Office of Research and Development

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De-implementation of Unnecessary Pre-Operative Urine Testing

Registry	NCT07411209
Status	Not yet recruiting
Phase	Not applicable
Study type	Interventional; randomized, sequential, masking: none, health services research
Enrollment	6 (Estimated)
Sponsor	VA Office of Research and Development (Fed)
Conditions	Urinary Tract Infection, Asymptomatic Bacteriuria
Interventions	Interventional Project Site Visit (Behavioral)
Dates	start 2026-12-31 (estimated), primary completion 2028-12-31 (estimated), completion 2030-12-31 (estimated), first posted 2026-02-13, last updated 2026-02-13
Locations	1 site in United States

-Summary

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.

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+Detailed 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.

+Arms and interventions

Arm	Type	Interventions	Description
Intervention Site Visit	Experimental	Behavioral: Interventional Project Site Visit	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.
Standard of Care	No intervention		VAMCs randomized to the standard arm will proceed with normal standard of care

Interventional Project Site Visit (Behavioral): Activities occurring during the 12-month intervention phase * 1:1 meetings introducing the project * Site Visit (once during intervention period) * Interactive teaching cases and didactic sessions * Distribution of algorithm as pocket cards * Access to project materials on SharePoint * Feedback reports on clinical outcomes * Evidence-based order set templates * Learning collaborative webinars * Individualized coaching

+Outcome measures

Primary outcomes

Number of Urine Testing Performed [up to 48 months]: Throughout the study period, the research team will generate monthly lists of all urinalyses and urine cultures performed within 30 days before and 30 days after included procedures. The study team will chart review theses cases and determine whether the urine test was done on an asymptomatic patient or whether the test was justified based on UTI symptoms.

Secondary outcomes

Number of Days of Therapy [up to 48 months]: Days of therapy is an aggregate sum of days on which an antimicrobial agent was administered to an individual patient. The investigators will include systemic antibacterial agents administered within 30 days before and 30 days after surgery. The investigators will exclude doses given as standard preoperative prophylaxis and antimicrobial agents that are not used for urinary tract infections.
Budget Impact Analysis [up to 48 months]: Time spent by sites will be converted into cost by multiplying the hourly wage rate plus benefits for each type of healthcare professional involved in the intervention

+Eligibility

Sex: All, ages: 18 Years to any

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

+Locations (1)

Facility	City	Country	Status
William S. Middleton Memorial Veterans Hospital, Madison, WI	Madison, Wisconsin	United States

+Investigators

Marin L. Schweizer-Looby, PhD BS, Principal investigator, William S. Middleton Memorial Veterans Hospital, Madison, WI

+Funding

NIH grants: I01RD000425