Lavelle Jane M, Blackstone Mercedes M, Funari Mary Kate, Roper Christine, Lopez Patricia, Schast Aileen, Taylor April M, Voorhis Catherine B, Henien Mira, Shaw Kathy N
Divisions of Pediatric Emergency Medicine and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Divisions of Pediatric Emergency Medicine and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Pediatrics. 2016 Jul;138(1). doi: 10.1542/peds.2015-3023. Epub 2016 Jun 2.
Urinary tract infection (UTI) screening in febrile young children can be painful and time consuming. We implemented a screening protocol for UTI in a high-volume pediatric emergency department (ED) to reduce urethral catheterization, limiting catheterization to children with positive screens from urine bag specimens.
This quality-improvement initiative was implemented using 3 Plan-Do-Study-Act cycles, beginning with a small test of the proposed change in 1 ED area. To ensure appropriate patients received timely screening, care teams discussed patient risk factors and created patient-specific, appropriate procedures. The intervention was extended to the entire ED after providing education. Finally, visual cues were added into the electronic health record, and nursing scripts were developed to enlist family participation. A time-series design was used to study the impact of the 6-month intervention by using a p-chart to determine special cause variation. The primary outcome measure for the study was defined as the catheterization rate in febrile children ages 6 to 24 months.
The ED reduced catheterization rates among febrile young children from 63% to <30% over a 6-month period with sustained results. More than 350 patients were spared catheterization without prolonging ED length of stay. Additionally, there was no change in the revisit rate or missed UTIs among those followed within the hospital's network.
A 2-step less-invasive process for screening febrile young children for UTI can be instituted in a high-volume ED without increasing length of stay or missing cases of UTI.
对发热幼儿进行尿路感染（UTI）筛查可能既痛苦又耗时。我们在一家繁忙的儿科急诊科实施了一项UTI筛查方案，以减少尿道插管，将插管仅限于尿袋标本筛查呈阳性的儿童。
这项质量改进举措采用了3个计划-实施-研究-改进循环，首先在一个急诊科区域对提议的变更进行小规模测试。为确保合适的患者得到及时筛查，护理团队讨论了患者风险因素并制定了针对特定患者的适当程序。在提供培训后，该干预措施扩展至整个急诊科。最后，在电子健康记录中添加了视觉提示，并编写了护理脚本以争取家庭参与。采用时间序列设计，通过使用p控制图来确定特殊原因变异，研究为期6个月的干预措施的影响。该研究的主要结局指标定义为6至24个月发热儿童的插管率。
在6个月的时间里，急诊科将发热幼儿的插管率从63%降至30%以下，且效果持续。超过350名患者避免了插管，同时未延长急诊科留观时间。此外，在医院网络随访的患者中，复诊率或漏诊UTI情况均未发生变化。
在繁忙的急诊科可以采用两步法的侵入性较小的流程对发热幼儿进行UTI筛查，而不会增加留观时间或漏诊UTI病例。
