Subscribe to RSS
DOI: 10.1055/a-2546-5868
Optimizing Wound Culture Ordering in Electronic Health Records: A Case Report
Funding Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under award Number UL1 TR003163. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH (National Institutes of Health).
Abstract
Background
At a large quaternary health system, tissue specimens were frequently sent to the microbiology laboratory with an incorrect wound culture order meant for swab specimens due to poor electronic health record (EHR) menu design. Wound cultures were also requested in chronic wound cases with a low index of suspicion for acute infection.
Objective
This study aimed to present a case report on specific changes to the design of the electronic test menu that resulted in higher numbers of appropriate ordering practices.
Methods
“Wound Culture” test was renamed to “Wound Swab Culture” to distinguish it from tissue specimens, and “Tissue Culture” was added as a new available quick order in the microbiology menu alongside the existing wound culture quick order. In addition, a diagnostic questionnaire was added to “Wound Swab Culture” quick orders that inquired about the presence of pus/exudate and erythema and if the wound was a surgical wound to guide and assess the appropriateness of the culture order.
Results
The number of tissue specimens erroneously submitted with a wound culture order decreased from 6.6% in July 2022 (preintervention) to 0% in July 2023 (postintervention). The diagnostic questionnaire was utilized in 27.5% of wound culture orders. In 6 out of 98 orders (6.1%), the wound was not surgical, and there was an absence of pus/exudate and erythema (p = 0.038). Conversely, 92 out of 98 orders (93.9%) had at least one “Yes” response. The total numbers of tests 6 months before and after the test menu design interventions showed that tissue culture orders increased from 228 prior to the intervention to 349 postintervention. Wound culture orders decreased from 575 to 460 (p < 0.0001).
Conclusion
Our case report underscores how targeted EHR optimization can be associated with more appropriate microbiology test ordering practices for potential wound infections.
Keywords
wound culture - tissue culture - EHR design - computerized provider order entry - EHR optimizationProtection of Human and Animal Subjects
This study was classified as a quality improvement initiative focused on enhancing antimicrobial stewardship processes and did not require informed consent from individual patients or Institutional Review Board approval.
* These authors contributed equally to this manuscript.
Publication History
Received: 15 September 2024
Accepted: 25 February 2025
Accepted Manuscript online:
27 February 2025
Article published online:
18 June 2025
© 2025. Thieme. All rights reserved.
Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany
-
References
- 1 Baron JM, Dighe AS. Computerized provider order entry in the clinical laboratory. J Pathol Inform 2011; 2: 35
- 2 Rudolf JW, Dighe AS. Decision support tools within the electronic health record. Clin Lab Med 2019; 39 (02) 197-213
- 3 Huang Y, Cao Y, Zou M. et al. A comparison of tissue versus swab culturing of infected diabetic foot wounds. Int J Endocrinol 2016; 2016: 8198714
- 4 Hurlow J, Bowler PG. Acute and chronic wound infections: microbiological, immunological, clinical and therapeutic distinctions. J Wound Care 2022; 31 (05) 436-445
- 5 Tang KWK, Millar BC, Moore JE. Antimicrobial resistance (AMR). Br J Biomed Sci 2023; 80: 11387
- 6 Edwards-Jones V. Antimicrobial stewardship in wound care. Br J Nurs 2020; 29 (15) S10-S16
- 7 Khajouei R, de Jongh D, Jaspers MW. Usability evaluation of a computerized physician order entry for medication ordering. Stud Health Technol Inform 2009; 150: 532-536