Non-invasive urinary tract infection screening for young infants: A high-value care initiative

Area of Science:

• Pediatrics
• Infectious Disease Control
• Healthcare Improvement

Background:

• Invasive urinary catheterization in infants is common but can lead to complications.
• Reducing unnecessary procedures is crucial for patient safety and resource optimization.
• Urinary tract infections (UTIs) require accurate diagnosis, often initiated by urine collection.

Purpose of the Study:

• To decrease invasive urinary catheterizations in infants (90 days to <6 months) by 50% over 24 months.
• To implement a safe, non-invasive screening pathway for UTIs in the emergency department.
• To evaluate the impact on catheterization rates, urine cultures, and patient safety outcomes.

Main Methods:

• A multi-professional team utilized the Model for Improvement framework.
• Implemented a modified 2-step urine bag screening pathway for UTI diagnosis.
• Utilized reminders and educational interventions to support the new pathway.

Main Results:

• Mean catheterization rate decreased from 62.5% to 43.9%, showing special cause variation.
• Mean urine culture rate decreased from 64.7% to 47.3%, also demonstrating special cause variation.
• No increase in length of stay or return visits; one potential missed UTI (1/843).

Conclusions:

• A 2-step non-invasive urine bag UTI screening pathway is effective and safe for infants aged 90 days and older.
• This pathway successfully reduces unnecessary urinary catheterizations and urine cultures in the emergency department.
• The intervention improves resource allocation without compromising patient safety or increasing adverse events.