• Zvi Shimoni, Paul Froom, Nathan Dusseldorp, and Jochanan Benbassat.
• Medical Director, Sanz Medical Center, Laniado Hospital, Netanya, Israel.
• J Eval Clin Pract. 2022 Aug 1; 28 (4): 566-568.

BackgroundRestricting the performance of microscopic urinalyses only to patients in whom it was specifically requested has been shown to reduce their number in laboratories servicing both inpatients and outpatients.ObjectiveTo determine the effect of such restriction solely in in-patients in a 400-bed regional hospital.MethodsIn 2017, we discontinued routine ('reflex') microscopic urinalysis for all positive dipstick results, and restricted such testing to in-patients in whom it was specifically requested by a doctor. We compared the numbers of patients in three internal medicine departments who had a urinalysis over 2-year periods before and after 2017, and reviewed doctors' complaints.ResultsBefore 2017, more than 80% of all dipstick tested samples had one or more abnormalities that led to a microscopic examination. Discontinuation of reflex microscopy reduced microscopic urinalysis to less than 10% of all patients with dipsticks on admission. Requests for repeat urinalysis decreased from 4.3% to 2.5% and there were no complaints after the change in policy.ConclusionsDiscontinuation of a 'reflex' microscopic urinalysis in patients with abnormal dipstick results did not increase repeat urine testing. Doctors apparently felt that the microscopic urinalysis does not have clinical utility in the vast majority of hospitalized adult patients.© 2021 John Wiley & Sons Ltd.

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