Implementing urine microscopy at Oklahoma State University Health Services: A medical student-led quality improvement project

Introduction/Objectives: Urine microscopy is a low-cost method for evaluating patients with urinary tract infections, metabolic disorders, and kidney disease. Despite clinician request, Oklahoma State University Health Services in Stillwater has not offered urine microscopy for over two years due to a lack of trained lab technicians. The goal of this quality improvement project was to improve one lab technician’s confidence with preparing and reading urine microscopy slides and to refine the training process for future trainees.

Methods: Before training, one lab technician rated her perceived confidence levels on a scale of 0 (not at all confident) to 10 (very confident) with sample preparation, microscopy skills, and recognition of urine microscopy features such as cells, casts, and crystals. The trainer and trainee then prepared and reviewed four slides per available urine sample (eight total slides). After this training session, self-reported confidence ratings were measured again. Qualitative feedback regarding urine microscopy training was also collected from the lab technician.

Results: Self-reported confidence ratings improved from 5 to 10 for sample preparation, from 0 to 7 for microscopy skills, and from 0 to 5.5 for recognition of urine microscopy features. Feedback for future urine microscopy training included updating the standardized operating procedure, organizing urine microscopy training materials into sections that correlate with the laboratory’s reporting system, and placing printed pictures of common urine microscopy findings near the microscope.

Conclusions: Initial urine microscopy training boosted confidence levels considerably. Future work includes implementing suggested changes for future trainees and pathologist review of prepared slides.