Evaluation of non-conformities in the drafting of bulletins for urine cytobacteriological examinations at Sikasso Hospital (Mali)

Introduction

A biological test report is a medical prescription for diagnostic purposes, specifying the parameter to be measured, in relation to the diagnostic hypothesis envisaged, and all the information needed for the laboratory to carry out the test correctly (1). Non-compliance in the prescription of medical biology tests makes it difficult to carry them out and interpret the results (2). A number of researchers have concluded that non-compliance has a number of possible consequences for patients, such as misdiagnosis, mismanagement and treatment, as well as therapeutic abstention (3). In Burkina Faso, 59.4% of non-compliances concerning clinical information were reported in a study in 2021 (2). In Niger, Djobo et al recorded 53.99% of non-compliances concerning failure to notify the name of the service on biological examination forms (4). In Mali, 41% of non-compliances concerning clinical information were found (5). With a view to continuous quality improvement and guaranteeing the quality of urine cytobacteriological examination (ECBU) results, we initiated this study with the aim of evaluating non-compliance in the drafting of ECBU reports analysed at the Sikasso Hospital laboratory.

Materials and methods

Results

During the study period, we identified 383 non-compliant reports out of 672, with a frequency of 56.99%. The non-compliances identified were related to age, profession, clinical information and residence (Tab. I).

The majority of non-compliance bulletins came from the medicine (35.51%) and urology (25.85%) departments (Fig. 1).

The non-compliances concerning age were 35.29% for the medicine department and 29.41% for the urology department. The lack of information on prescriptions in the urology department was 41.98%, and 21.60% in the nephrology department. The absence of clinical information was frequent on the urology department forms (44.19%). Non-compliances concerning residence accounted for 39.08% for medicine and 22.70% for urology.

Study limitations

The non-conformities concerned only ECBU bulletins, which justifies their high frequency during the course of this work.

Discussion

Prescription is the result of careful consideration, taking into account the epidemiological and clinical context on the one hand, and precise knowledge of what can be expected from the examination on the other (6). ECBU reports received during the course of this study were 56.99% non-compliant. Yacouba et al in Burkina Faso reported a non-compliant rate of 5.2% (2). Our result could be explained by the size of our sample, which was not large enough, and by the fact that the study was limited to ECBU reports. The majority of non-compliant reports came from medicine (35.51%) and urology (25.85%) departments. Djobo et al found 3.64% and 1.33%, respectively, for the medicine and urology departments (4). This could be explained by automatic prescribing, which is often based on personal habits rather than established protocols (6). In our study, non-compliance relating to clinical information accounted for 6.70%. This proportion is lower than that reported by Djobo et al, who found the rate to be 46.63%. This situation could be explained by the lack of awareness of the importance of this parameter in the interpretation of ECBU by several of our prescribers (4). Including clinical and therapeutic information can help the biologist in choosing the technique to be used, or lead him/her to advise against a costly investigation and suggest a more appropriate one (2). Age was missing from 2.68% of the forms in our study. This low rate confirms our prescribers’ mastery of the impact of this parameter in interpreting the results (2). Those with no occupation or residence accounted for 24.40% and 52.08%, respectively. These socio-demographic parameters are one of the factors that will add value to our knowledge of the factors that contribute to urinary tract infections. Reporting them on ECBU reports will be of epidemiological interest.

Conclusion

This study has provided information on the completeness of ECBU reports. The high frequency of non-compliance is a cause for concern and is of concern to all prescribers in the hospital. Close collaboration between prescribers and biologists would help to control non-compliance in the drafting of examination reports.

Conflicts of interest

The authors declare that they have no competing interests.

Authors’ contributions

Luka Diarra collected the data and wrote the article. Moussa Mariko contributed to the data analysis. All other authors reviewed and approved the final manuscript.

Funding

The authors received no funding for this work.

Acknowledgements

The authors sincerely thank all the staff of Sikasso Hospital for their contributions. Special thanks to the general management of the hospital for their support throughout the process.