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Applying Quality Improvement Methodology to Standardize Pediatric Urinary Tract Infection Diagnosis and Management
Shannon H Baumer-Mouradian1, Lia C Bradley2, Sadia T Ansari3
1From the Department of Pediatrics, Medical College of Wisconsin, Children's Corporate Center, Milwaukee, Wis.
Insights
Implementing a standardized pathway improved first-line cephalexin prescribing for pediatric urinary tract infections (UTIs) from 34% to 66%. This enhanced antibiotic stewardship without increasing patient return visits for UTIs.
Area of Science:
- Pediatric infectious diseases
- Antimicrobial stewardship
- Healthcare quality improvement
Background:
- Pediatric urinary tract infections (UTIs) require prompt diagnosis and treatment to prevent complications.
- Significant variability in UTI management was observed across a large healthcare system.
- Antibiotic stewardship guidelines recommended cephalexin as a preferred first-line agent for UTIs.
Purpose of the Study:
- To increase the first-line prescription rate of cephalexin for uncomplicated pediatric UTIs.
- To improve adherence to antibiotic stewardship recommendations within a regional health system.
- To achieve a target of 75% first-line cephalexin use for pediatric UTIs within six months.
Main Methods:
- A multidisciplinary team developed interventions including a standardized UTI pathway, EHR enhancements, and provider education.
- The project utilized Plan-Do-Study-Act cycles for iterative implementation and monitoring.
- Data on cephalexin prescribing and 14-day UTI-related return visits were collected and analyzed.
Main Results:
- First-line cephalexin prescribing for UTIs increased from a baseline of 34% to 66% after pathway implementation.
- No significant change was observed in the rate of 14-day return visits for UTI-related diagnoses.
- The interventions demonstrated a substantial improvement in guideline adherence.
Conclusions:
- Standardizing UTI diagnosis and management protocols improved system-wide adherence to antibiotic stewardship guidelines.
- The initiative successfully enhanced the use of appropriate empiric antibiotic therapy for pediatric UTIs.
- Multidisciplinary collaboration and data-driven cycles are effective for improving clinical practice.
Background:
Pediatric urinary tract infections (UTIs) require early diagnosis and appropriate treatment to avoid short- and long-term morbidity. Baseline data from 13,000 children across a regional health system demonstrated wide variation in UTI management, including antibiotic choice, duration, and dosing. In 2019, the local antibiotic stewardship team recommended cephalexin as the ideal first-line UTI treatment due to its effectiveness, narrow spectrum, low cost, and palatability. This project aimed to improve first-line prescription of cephalexin as an empiric antibiotic treatment for uncomplicated UTIs from 34% to 75% in children 60 days to 18 years of age presenting to any site within the healthcare system within 6 months.
Methods:
A multidisciplinary team of key stakeholders reviewed baseline data and developed three key drivers. These included a standardized UTI pathway, electronic health record enhancements, and provider education. Interventions were supported by a literature review and implemented via Plan-Do-Study-Act cycles with data monitored bimonthly. The primary outcome was the percentage of patients prescribed cephalexin for presumed UTI over the total number of presumed UTI diagnoses treated with empiric antibiotics throughout the healthcare system. The balancing measure included 14-day return visits for a UTI-related diagnosis across the system.
Results:
After the release of the updated UTI pathway, first-line cephalexin prescribing for UTI improved from 34% to 66%. There was no change in 14-day revisits for UTI.
Conclusions:
Standardizing the diagnosis and management of UTIs across the spectrum of coordinated care led to improved system-wide adherence to local antibiotic stewardship guidelines for empiric UTI treatment.
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