Workflow Interventions in the Emergency Department Associated With Reduced Urine Specimen Collection Times

Delays in urine specimen (UA) collection in the Emergency Department (ED) can contribute to significant diagnostic delays and prolonged length of stay (LOS). Workflow interventions were implemented to encourage early specimen collection, including increased specimen cup availability, improved signage, and creating a new workflow for patient hydration and straight catheterization. The study objective was to evaluate the impact of these workflow, non-EHR based interventions on UA order-to-collection time and overall ED LOS.

Retrospective pre- and post-intervention analysis of adult ED encounters with UA order between 6/18/25-11/18/25 at a large urban academic center. The primary outcome was the time from UA order to collection and the secondary outcome was ED LOS. Median time to collection and length of stay were compared pre- and post-intervention using bootstrapped quantile regression with 500 repetitions adjusted for age, sex, and ESI. Time to collection was also broken up into 30 minutes epochs and the proportion of patients falling into those epochs was compared using -chi-squared or Fisher’s exact tests. Pre- and post-intervention location of order and collection were compared using Fisher’s exact tests.

Median time to collection decreased from 96 (IQR: 25, 223) pre- to 87 (IQR: 20, 213) minutes post-intervention (adjusted median decreased of 13 mins ([95% CI: -23, -7], p<0.001 ) . There was a significant increase in quantity of order-to-collection time collections in < 30 mins epoch from 27% to 29% (p=0.042). More urine specimens were ordered in the WR and collected in either the WR (18% to 27%, p<0.001) or ED (26% to 28%, p=0.031) and fewer ordered and collected in the ED (57% to 45%, p<0.001). There was no significant difference in order to collection time when stratified by order/collection location. Adjusted LOS increased a median of 34 ([95% CI: 8-60], p=0.011) minutes in the post-intervention compared to the pre-intervention period.

Workflow interventions such as signage and urine cup availability were associated with decreased urine order-to-collection times and higher percentage of tests ordered and collected in the WR and fewer in the ED treatment space. However, ED LOS increased, likely confounded by patient volume and boarding times and suggests other downstream bottlenecks.