CAP TODAY Pathology/Laboratory Medicine/Laboratory Management
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Instrument automatically generates consolidated report*:
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*chemistry and microscopy results in one report; Note: a dash in lieu of an answer means company did not answer question or question is not applicable:
In urinalysis, compromises, collections, and rules
March 2024—Reflex criteria, middleware, bladder cancer screening, point of care, controls, and collections came up in CAP TODAY’s Jan. 16 roundtable on urinalysis. Six people weighed in, with CAP TODAY publisher Bob McGonnagle leading. Their take on where things stand and where they can be better follows. CAP TODAY’s guide to urinalysis instrumentation begins here.
Dr. Skelton
Tim Skelton, in last year’s urinalysis roundtable we spoke about the need for reflex testing. One of our roundtable participants said that without reflex testing, his laboratory had an unacceptably high rate of false-positive urine cultures. The laboratory adopted reflex testing, and the result was a dramatic improvement in patient care and laboratory efficiency. Is reflex testing a hot topic for you at Lahey?
Timothy Skelton, MD, PhD, medical director, core laboratory and clinical informatics, Lahey Hospital and Medical Center, and medical director, laboratory and pathology informatics, Beth Israel Lahey Health: It is. Two clinical groups with different priorities have competing interests. One is primary care providers and the emergency department. They don’t want to miss any urinary tract infections, and to give them a false-negative is problematic. The other is the infectious disease group and the pharmacy. Their primary interest is antibiotic stewardship. They don’t want to prescribe an antibiotic unless there’s a UTI diagnosis. They have a different opinion about what the reflex criteria should be. So we do the full urinalysis—chemistry and microscopic. Ten to 15 percent of the time we have a negative chemistry dipstick but significant findings on the microscopic—it’s either red cells or white cells and then rarely crystals. We do 100 percent microscopic on all our urinalysis, so we can use the microscopic as our reflex criteria. We have decided on a white blood cell count of 10 per high-power field. If it’s above that, we reflex the urine culture.
Is that the Solomonic lab value that satisfies both ends of your clinical demand?
Dr. Skelton (Beth Israel Lahey Health): It’s a compromise. For a while we required bacteria to be present, but the ED had examples in which there were significant white cells but a bacteria count below the cutoff and the patient was not treated and then found to have a fulminant UTI later. We decided we wouldn’t suppress the reflex based on lack of bacteria.