WIP 16 - Expanding a two-step pathway for non-invasive urinary tract infection screening for children 90 days and older on the pediatric inpatient units
Resident Physician The Hospital for Sick Children University of Toronto Toronto, Ontario, Canada
Background: Urinary tract infections (UTIs) are a common source of fever in young children. Diagnostic best practice includes interpreting a urinalysis (UA) and urine culture. A two-step approach has previously demonstrated a reduction in unnecessary catheterizations in children 6 - 24 months with suspected UTIs. This consists of a screening UA on a non-invasive urine bag sample, followed by a urine culture obtained by catheterization if the UA is positive. This approach was successfully implemented in the Emergency Department (ED) at our institution. In April 2021 it was adopted on the inpatient pediatric medicine units using the Model for Improvement.
Newer guidelines suggest that non-invasive UTI screening may be safely adopted in children < 6 months of age. Our institution’s ED has modified the UTI screening pathway to include infants ≥90 days. Initial data demonstrates a further reduction of unnecessary catheterizations with no missed UTIs. We hypothesize that expanding the age range on pediatric inpatient units will have a similar effect. Aligning ED and inpatient unit pathways will also establish a clear institution-wide policy for investigating UTIs. Objective: Our aim is to expand the age of our two-step UTI screening pathway to include infants ≥90 days, and to decrease the number of unnecessary bladder catheterizations by 50% on the pediatric inpatient units between September 2023 to April 2024. Design/Methods: The pre-existing inpatient two-step pathway was modified by a multidisciplinary team to reflect the ED pathway. Changes to the screening approach were approved by the Institutional Review Board for Quality Improvement at our institution. The revised pathway was implemented in September 2023 using the Model for Improvement. Ongoing interventions include just-in-time education for trainees and staff alongside ongoing process standardization which will be implemented using multiple Plan-Do-Study-Act cycles. Data collection will continue monthly. Outcome and fidelity measures will be analyzed using statistical process control methods and descriptive statistics.
