Abstract
BACKGROUND: Urinary tract infections (UTIs) are a common source of infection in children. Best practice for diagnosis includes interpreting a urinalysis (UA) and urine culture. Urine cultures obtained through bladder catheterization are invasive and time consuming. A two-step approach with noninvasive UA screen, followed by urine culture if positive has previously demonstrated a reduction in unnecessary catheterizations and urine cultures in children 6-24 months with suspected UTIs. Pre-intervention, there was inconsistent use of screening point-of-care urinalysis prior to bladder catheterization for culture. OBJECTIVES: To decrease the number of bladder catheterizations in children 6-24 months with a negative screen on Point of Care Test (POCT) urinalysis by 25% over 1 year on paediatrics wards at a paediatric tertiary care centre. Outcome measures: 1. Proportion of bladder catheterizations with negative or no UA screen prior 2. Proportion of UA completed as POCT rather than lab sample Process measures: 1. Number of urinary catheterizations performed for UTI screen 2. Number of times pathway is followed Balancing measure: 1. Missed UTIs DESIGN/METHODS: Baseline data was collected from the paediatric inpatient units at a tertiary paediatric hospital from April 2020 – April 2021. A two-step pathway for collecting urine samples was adopted, including POCT UA screen on a bag sample, followed by bladder catheterization for culture if positive. The pathway was implemented using the Model for Improvement and multiple PDSA cycles. Intervention focused on education, interdisciplinary collaboration, and process standardization. RESULTS: Baseline data demonstrated a high rate of urinary catheter cultures despite a negative UA or no UA prior (69%). After pathway implementation, this rate decreased to 23%, with a reduction in initial UA collected by catheter from 14% to 5% (figure 1). The number of POCT UA performed has increased from a median of 64% pre-intervention to 80% post-intervention, resulting in fewer samples processed in the lab (figure 2). CONCLUSION: Variability in practice for specimen choice for collection and investigation contributed to unnecessary catheterizations. Process standardization successfully improved patient-centered care and efficiency. Next steps include broadening pathway inclusion criteria to the 3–6-month age group. POTENTIAL COMPETING INTERESTS: This work was partially supported by the UMC (Utilization Management Committee) Resource Stewardship Grant. The authors declare no additional sources of funding or conflicts of interest.