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Health Equity/Community Health

Poster Session 4

(933) Policy Change Combined with Clinical Decision Support Improves Equity and Yield of L&D UDS Testing

Wednesday, February 14, 2024
1:00 PM – 2:30 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: An indication of isolated tetrahydrocannabinol (THC) use for urine drug screening (UDS) in labor and delivery units is a poor predictor of other substance exposure and leads to inequities in downstream harms (e.g. reporting to state child abuse hotline). In September 2022, the Labor and Delivery unit at an urban tertiary care center removed isolated THC use as an indication for UDS. Concurrently, an electronic health record (EHR)-based order question was implemented requiring providers to select an indication for testing. We sought to assess the impact of these changes on UDS ordering practices.

Study Design: We performed a retrospective cohort study of all UDS results from an inpatient obstetric unit at an urban tertiary care center from June 2020-July 2023. Urine drug screening is performed based on verbal screening of all admitted patients. Statistical testing for comparing pre- vs. post-testing periods was performed using Pearson’s chi-square. 

Results: 2056/8271 (24.9%) and 209/2247 (9.3%) of all deliveries in the pre- and post-implementation periods had UDS performed, respectively (p< 0.001). 1356/4013 (33.8%) and 665/3647 (18.2%) (p< 0.001) of deliveries in the pre-implementation period had UDS performed for Black and White patients, respectively, vs. 107/1008 (10.6%) and 97/1070 (9.1%) of deliveries in the post-implementation period (p=0.32). The rate of UDS results positive only for THC decreased from 512/2056 (24.9%) to 22/209 (10.5%) (p< 0.001) in the pre- vs. post-implementation periods.

Conclusion: Following the interventions, significantly fewer UDS’s were performed overall and a race-based difference in the rate of UDS was significantly reduced. Additionally, a significant decrease was observed in the UDS positivity rate for non-THC substances in the pre- vs. post-intervention periods, suggesting that the removal of the isolated THC use order indication led to fewer THC-only positive UDS results. These results suggest that removal of isolated THC use as an indication and implementation of an indication order question can reduce low-yield UDS and reduce race-based UDS disparities.