From the Division of Paediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Pediatr Emerg Care. 2024 Nov 1;40(11):812-817. doi: 10.1097/PEC.0000000000003228. Epub 2024 Aug 23.
Obtaining urine samples in younger children undergoing urinary tract infection (UTI) screening can be challenging in busy emergency departments (EDs), and sterile techniques, like catheterization, are invasive, traumatizing, and time consuming to complete. Noninvasive techniques have been shown to reduce catheterization rates but are variably implemented. Our aim was to implement a standardized urine bag UTI screening approach in febrile children aged 6 to 24 months to decrease the number of unnecessary catheterizations by 50% without impacting ED length of stay (LOS) or return visits (RVs).
After forming an interprofessional study team and engaging key stakeholders, a multipronged intervention strategy was developed using the Model for Improvement. A urine bag screening pathway was created and implemented using Plan, Do, Study Act (PDSA) cycles for children aged 6 to 24 months being evaluated for UTIs. A urine bag sample with point-of-care (POC) urinalysis (UA) was integrated as a screening approach. The outcome measure was the rate of ED urine catheterizations, and balancing measures included ED LOS and RVs. Statistical process control methods were used for analysis.
During the 3-year study period from January 2019 to June 2022, the ED catheterization rate successfully decreased from a baseline of 73.3% to 37.7% and was sustained for approximately 2 years. Unnecessary urine cultures requiring microbiology processing decreased from 79.8% to 40.7%. The ED LOS initially decreased; however, it increased by 17 minutes during the last 8 months of the study. There was no change in RVs.
A urine bag screening pathway was successfully implemented to decrease unnecessary, invasive catheterizations for UTI screening in children with only a slight increase in ED LOS. In addition to the urine bag pathway, an ED nursing champion, strategic alignment, and broad provider engagement were all instrumental in the initiative's success.
在小儿尿路感染（UTI）筛查的繁忙急诊部（ED）中，获取年幼儿童的尿液样本可能具有挑战性，而像导管插入术这样的无菌技术具有侵入性、创伤性并且需要花费大量时间才能完成。非侵入性技术已被证明可以降低导管插入率，但实施情况各不相同。我们的目的是在 6 至 24 个月发热的儿童中实施标准化的尿袋 UTI 筛查方法，以将不必要的导管插入率降低 50%，而不会影响 ED 住院时间（LOS）或复诊（RV）。
在组建一个多学科研究团队并让关键利益相关者参与后，我们使用改进模型制定了一项多管齐下的干预策略。为 6 至 24 个月的 UTI 评估儿童创建并实施了尿袋筛查途径，并使用 Plan-Do-Study-Act（PDSA）循环。将即时护理（POC）尿液分析（UA）的尿袋样本作为筛查方法。结果测量指标是 ED 尿液导管插入率，平衡指标包括 ED LOS 和 RV。使用统计过程控制方法进行分析。
在 2019 年 1 月至 2022 年 6 月的 3 年研究期间，ED 导管插入率从基线的 73.3%成功降低至 37.7%，并持续了大约 2 年。需要微生物处理的不必要尿液培养物从 79.8%减少至 40.7%。ED LOS 最初下降，但在研究的最后 8 个月增加了 17 分钟。RV 没有变化。
成功实施了尿袋筛查途径，以减少儿童 UTI 筛查中不必要的侵入性导管插入术，仅使 ED LOS 略有增加。除了尿袋途径，ED 护理冠军、战略一致性和广泛的提供者参与都是该计划成功的关键。
