Applying Quality Improvement Methodology to Standardize Pediatric Urinary Tract Infection Diagnosis and Management throughout a Healthcare System. Pediatr Qual Saf 2024;9(5):e756
Date
08/22/2024Pubmed ID
39169948Pubmed Central ID
PMC11338250DOI
10.1097/pq9.0000000000000756Scopus ID
2-s2.0-85201786604 (requires institutional sign-in at Scopus site) 2 CitationsAbstract
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.
Author List
Baumer-Mouradian SH, Bradley LC, Ansari ST, Chinta SS, Mitchell ML, Nelson AM, Marusinec LE, Wake KM, Mantey KA, Cabrera IC, De Valk JA, Hanson AP, Witkowski EM, Bushee GM, Ellison JSAuthors
Shannon H. Baumer-Mouradian MD Associate Professor in the Pediatrics department at Medical College of WisconsinSri S. Chinta MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Jonathan Scott Ellison MD Associate Professor in the Urologic Surgery department at Medical College of Wisconsin
Michelle Mitchell MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Anika M. Nelson MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
