Why are we misdiagnosing urinary tract infection in older patients? A qualitative inquiry and roadmap for staff behaviour change in the emergency department

Key summary points Aim This study sough to determine the psychological and behavioural factors contributing to the incorrect diagnosis of urinary tract infection in older adults and identify potential interventions that can address the incorrect diagnosis of urinary tract infection in older adults? Findings The findings were that the misdiagnosis of UTI, particularly in older people, is driven by complex, interconnected psychological and behavioural factors, such as lack of knowledge on the role of urine dip testing, bias towards older people, automatic testing, time and resource constraints, pressures from peers and patients and legal pressures. Developing interventions that address the disconnect between knowledge and practice by encompassing both psychological and behavioural factors may improve patient safety and staff satisfaction. Messages Urine dipstick testing in the ED is often misinterpreted, leading to misdiagnosis which may then impact negatively on patient safety; the reasons this knowledge-practice disconnect exists are multi-factorial, but psychological and behavioural factors play a significant role. Systematic approaches incorporating these factors can potentially improve patient safety, efficiency, costs from unnecessary testing and staff satisfaction.