De-implementing PreOp Urine Testing

De-implementation of Unnecessary Pre-Operative Urine Testing

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.

Study Overview

• Status: Not yet recruiting
• Conditions: Urinary Tract Infection; Asymptomatic Bacteriuria
• Intervention / Treatment: Behavioral: Interventional Project Site Visit

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.

• Study Type: Interventional
• Enrollment (Estimated): 6
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Marin L Schweizer-Looby, PhD BS; Phone Number: (608) 256-1901; Email: Marin.Schweizer-Looby@va.gov

Study Locations

• United States
  • Wisconsin
    • Madison, Wisconsin, United States, 53705-2254
      • William S. Middleton Memorial Veterans Hospital, Madison, WI
      • Contact: Julie A Keating, PhD; Phone Number: 12542 608-256-1901; Email: julie.keating@va.gov
      • Principal Investigator: Marin L. Schweizer-Looby, PhD BS

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

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

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Randomized
• Interventional Model: Sequential Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Intervention 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.	Behavioral: Interventional Project Site Visit; 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
No Intervention: Standard of Care; VAMCs randomized to the standard arm will proceed with normal standard of care

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Urine Testing Performed	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.	up to 48 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Number of Days of Therapy	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.	up to 48 months
Budget Impact Analysis	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	up to 48 months

Collaborators and Investigators

• Sponsor: VA Office of Research and Development
• Investigators: Principal Investigator: Marin L. Schweizer-Looby, PhD BS, William S. Middleton Memorial Veterans Hospital, Madison, WI

Study record dates

Study Major Dates

• Study Start (Estimated): December 31, 2026
• Primary Completion (Estimated): December 31, 2028
• Study Completion (Estimated): December 31, 2030

Study Registration Dates

• First Submitted: February 3, 2026
• First Submitted That Met QC Criteria: February 10, 2026
• First Posted (Actual): February 13, 2026

Study Record Updates

• Last Update Posted (Actual): February 13, 2026
• Last Update Submitted That Met QC Criteria: February 10, 2026
• Last Verified: February 1, 2026

More Information

Terms related to this study

• Keywords: antibiotic stewardship; kicking cauti
• Additional Relevant MeSH Terms: Urogenital Diseases; Male Urogenital Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Infections; Urinary Tract Infections
• Other Study ID Numbers: HSR5-024-24W; I01RD000425-01A2 (Other Grant/Funding Number: VA Research & Development)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No