Process Mapping in a Pediatric Emergency Department to Minimize Missed Urinary Tract Infections

Area of Science:

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

Background:

• Urinary tract infections (UTIs) are prevalent in young children and frequently present in emergency departments (EDs).
• Untreated UTIs can escalate to severe health complications, necessitating effective diagnostic and treatment protocols.
• A newly established tertiary care pediatric emergency department (PED) aimed to improve UTI detection and management.

Purpose of the Study:

• To implement a quality improvement (QI) initiative to minimize missed UTIs in children under 3 years old.
• To evaluate the effectiveness of process mapping (PM) as a QI tool in a pediatric acute care setting.
• To reduce the incidence of delayed or absent treatment and follow-up for pediatric UTIs.

Main Methods:

• Retrospective chart review of children < 3 years old with positive urine cultures in the ED.
• Process mapping (PM) involving key stakeholders to identify gaps and barriers in UTI care.
• Implementation of targeted interventions based on PM findings.
• Follow-up chart review to assess the impact of implemented interventions.

Main Results:

• Initial chart review revealed 12% of positive urine cultures had no recorded treatment or follow-up, indicating potential missed UTIs.
• Following PM and intervention implementation, the rate of no treatment or follow-up dropped to 1%.
• A dramatic decrease in potentially missed UTIs was observed post-QI initiative.

Conclusions:

• Process mapping is an effective QI tool for reducing missed UTIs in pediatric emergency settings.
• QI initiatives can significantly improve the timely diagnosis and management of UTIs in young children.
• Streamlined processes in the ED are crucial for preventing severe outcomes from pediatric UTIs.