Improving Adherence to Evidence-based Practice for Uncomplicated UTI in a Pediatric Emergency Department

Jaclyn N Kline; Lauren N Powell; Jonathan D Albert; Amy C Bishara; Joshua C Heffren; Gia M Badolato; Deena D Berkowitz

doi:10.1097/pq9.0000000000000654

Improving Adherence to Evidence-based Practice for Uncomplicated UTI in a Pediatric Emergency Department

Pediatr Qual Saf. 2023 May 22;8(3):e654. doi: 10.1097/pq9.0000000000000654. eCollection 2023 May-Jun.

Authors

Jaclyn N Kline^{1

2}, Lauren N Powell^{1

3}, Jonathan D Albert^{1

3}, Amy C Bishara^{1

3}, Joshua C Heffren⁴, Gia M Badolato^{1

2}, Deena D Berkowitz^{1

2}

Affiliations

¹ From the George Washington University School of Medicine & Health Sciences, Washington, D.C.
² Division of Emergency Medicine, Children's National Hospital, Washington, D.C.
³ Division of Infectious Disease, Children's National Hospital, Washington, D.C.
⁴ Division of Pharmacy Services, Children's National Hospital, Washington, D.C.

Abstract

Introduction: Uncomplicated urinary tract infections (uUTIs) are among the more common pediatric bacterial infections. Despite their prevalence, significant variability exists in the treatment duration and antibiotic selection for uUTI. Our first aim was to improve adherence to a three-day course of antibiotic treatment for uUTI in children over 24 months old. Our second aim was to increase the selection of cephalexin in this population.

Methods: We conducted a single-center quality improvement study from March 2021 to March 2022. One thousand four hundred thirty-five patients were included across our baseline and intervention periods. We created an order set with embedded discharge prescriptions and followed this with education and provider feedback. The outcome measures for this study were percent of children receiving 3 days of antibiotic treatment and percent of children prescribed cephalexin. In addition, we tracked order set use as a process measure, and 7-day emergency department revisit as a balancing measure.

Results: Rates of 3-day prescriptions for uUTI demonstrated special cause variation with an increase from 3% to 44%. Prescription rates of cephalexin for uUTI demonstrated special cause variation with an increase from 49% to 74%. The process measure of order set use improved from 0% to 49% after implementation. No change occurred in 7-day emergency department revisits.

Conclusion: We demonstrated improved use of shorter course therapy for uUTI with a first-generation cephalosporin throughout this project without adverse events. We leveraged an order set with embedded discharge prescriptions to achieve our goals.