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

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Morgan Black ◽  
Valene Singh ◽  
Vladimir Belostotsky ◽  
Madan Roy ◽  
Deborah Yamamura ◽  
...  
Keyword(s):  
Emergency Department ◽  
Urinary Tract ◽  
Chart Review ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
Process Mapping ◽  
Number Of Children ◽  
Positive Urine ◽  
Tract Infections

Urinary tract infections (UTIs) are common in young children and are seen in emergency departments (EDs) frequently. Left untreated, UTIs can lead to more severe conditions. Our goal was to undertake a quality improvement (QI) initiative to help minimize the number of children with missed UTIs in a newly established tertiary care pediatric emergency department (PED). A retrospective chart review was undertaken to identify missed UTIs in children < 3 years old who presented to a children’s hospital’s ED with positive urine cultures. It was found that there was no treatment or follow-up in 12% of positive urine cultures, indicating a missed or possible missed UTI in a significant number of children. Key stakeholders were then gathered and process mapping (PM) was completed, where gaps and barriers were identified and interventions were subsequently implemented. A follow-up chart review was completed to assess the impact of PM in reducing the number of missed UTIs. Following PM and its implementation within the ED, there was no treatment or follow-up in only 1% of cases. Based on our results, the number of potentially missed UTIs in the ED decreased dramatically, indicating that PM can be a successful QI tool in an acute care pediatric setting.

Urinary Tract Infections in Febrile Infants Younger Than 8 Weeks of Age

PEDIATRICS ◽  
1990 ◽  
Vol 86 (3) ◽  
pp. 363-367 ◽  
Author(s):  
Ellen F. Crain ◽  
Jeffrey C. Gershel
Keyword(s):  
Emergency Department ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Urine Culture ◽  
White Blood Cells ◽  
Laboratory Data ◽  
Pediatric Emergency ◽  
Urine Specimen ◽  
High Power Field ◽  
Tract Infections

In this prospective study of 442 infants younger than 8 weeks of age who attended a pediatric emergency department with temperature ≥100.6°F (38.1° C), urinary tract infections (UTIs) were found in 33 patients (7.5%), 2 of whom were bacteremic. Clinical and laboratory data were not helpful for identifying UTIs. Of the 33 patients with UTIs, 32 had urinalyses recorded; 16 were suggestive of a UTI (more than five white blood cells per high-power field or any bacteria present). Of the 16 infants with apparently normal urinalysis results, three had an emergency department diagnosis suggesting an alternative bacterial focus of infection. If the physician had decided on the basis of apparently normal urinalysis results to forgo obtaining a urine culture, more than half of the UTIs would have been missed. Bag-collected specimens were significantly more likely to yield indeterminate urine culture results than either catheter or suprapublic specimens. In addition, uncircumcised males were significantly more likely to have a UTI than circumcised boys. These results suggest that a suprapubic or catheter-obtained urine specimen for culture is a necessary part of the evaluation of all febrile infants younger than 8 weeks of age, regardless of the urinalysis findings or another focus of presumed bacterial infection.

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