Optimizing Wound Culture Ordering in Electronic Health Records: A Case Report.

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 menu design. Wound cultures were also requested in chronic wound cases with a low index of suspicion for acute infection.

Objective: 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 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 (pre-intervention) to 0% in July 2023 (post-intervention). 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 absence of pus/exudate and erythema (p = 0.038). Conversely, 92 out of 98 orders (93.9%) had at least one "Yes" response. Total numbers of tests six months before and after the test menu design interventions showed that tissue culture orders increased from 228 prior to the intervention to 349 post-intervention. Wound culture orders decreased from 575 to 460 (p < 0.0001).

Conclusions: Our case report underscores how targeted electronic health record optimization can be associated with more appropriate microbiology test ordering practices for potential wound infections.