Two-Step Process for ED UTI Screening in Febrile Young Children: Reducing Catheterization Rates

Area of Science:

• Pediatric Emergency Medicine
• Quality Improvement Science
• Infectious Disease Screening

Background:

• Urinary tract infection (UTI) screening in febrile young children often involves painful and time-consuming methods like urethral catheterization.
• High-volume pediatric emergency departments (EDs) face challenges in efficiently screening young children for UTIs.

Purpose of the Study:

• To implement and evaluate a less-invasive UTI screening protocol in a pediatric ED.
• To reduce the rate of urethral catheterization in febrile young children requiring UTI screening.

Main Methods:

• A quality improvement initiative using Plan-Do-Study-Act cycles was implemented in a high-volume pediatric ED.
• The protocol limited catheterization to children with positive urine bag screens, incorporating risk factor assessment and electronic health record cues.
• A time-series design with p-charts analyzed the catheterization rate in febrile children aged 6-24 months over a 6-month period.

Main Results:

• Catheterization rates for febrile young children decreased from 63% to under 30% within 6 months, with sustained results.
• Over 350 patients avoided catheterization without increasing ED length of stay.
• No increase in UTI revisit rates or missed diagnoses was observed within the hospital network.

Conclusions:

• A 2-step, less-invasive UTI screening process is feasible in high-volume pediatric EDs.
• This protocol effectively reduces unnecessary catheterizations without compromising diagnostic accuracy or patient flow.
• The findings support the adoption of this improved screening strategy for febrile young children.