Why was a change in practice needed?

There is pressure on the NHS as a whole to reduce costs to meet the challenge of the NHS Five Year Forward View of delivering an estimated £22 billion of productivity improvements by 2020/2021.1 One opportunity to save money is to deliver care according to best practice guidelines. We therefore decided to focus on managing patients with suspected bacterial urinary tract infections (UTIs) as there are best practice guidelines available. In 2014 our integrated Sexual Health Service in the North East of England sent 849 mid-stream urine (MSU) samples to the local laboratory costing £3956. The Scottish Intercollegiate Guidelines Network (SIGN) has produced a guideline for the management of suspected bacterial UTIs in adults (SIGN 88) which provides recommendations, based on current evidence for best practice, for diagnosing and managing adults with community acquired lower UTIs.2

A summary of the SIGN 88 guideline for the management of suspected bacterial UTIs in adults is shown in box.