Objectives

In the pediatric emergency department (ED), patients are diagnosed with urinary tract infections (UTIs) and prescribed antibiotics based on urinalysis results while awaiting urine cultures (UCs). If UCs are not consistent with UTIs, antibiotics can be discontinued. Previously, our ED physicians did not contact patients with contaminant UCs, and antibiotics were continued unnecessarily. For patients diagnosed with UTIs but having contaminant UCs, we aimed to increase the percentage of antibiotics discontinued from 3% to 75% in 6 months.

Methods

Interventions focused on physician education, physician feedback, and training Resource Nurse Line staff to contact families regarding UCs. Outcome measures were the percentage of patients with contaminant UCs who had antibiotics discontinued and the average antibiotic duration for patients with contaminant UCs. Process measures included the percentage of patients who providers called. Balancing measures included the percentage of patients who had antibiotics discontinued and returned to the ED within 7 days with persistent urinary symptoms. We used statistical process control to examine changes in measures over time.

Results

The percentage of patients with antibiotics discontinued increased from 3% to 61% within 10 months, with this change sustained for an additional 12 months. The average antibiotic duration decreased from 7.3 to 4.5 days. The percentage of patients called increased from 5% to 82%. Of the patients who discontinued antibiotics, 1% returned to the ED and were again diagnosed with UTIs.

Conclusions

We increased the percentage of patients with contaminant UCs who had antibiotics discontinued and demonstrated sustainability.