Implementation of a Urinary Tract Infection Management Pathway to Evaluate Emergency Department Length of Stay in a Pediatric Emergency Department

Abstract

Point-of-care urine testing is an alternative to urine microscopy in children. However, it remains unclear if utilizing point-of-care urine testing without urine microscopy decreases length of stay in the emergency department (ED). We implemented a point-of-care-driven urinary tract infection management pathway to evaluate effects on length of stay. This was an uncontrolled before and after study examining a point-of-care urinalysis pathway in a children's ED. We obtained preliminary data by prospectively evaluating urine microscopy. We then implemented a pathway in which point-of-care urine testing determined treatment and disposition. Outcomes included time from urinalysis order to discharge order, length of stay, and rate of delayed treatment. A total of 118 patients were enrolled before pathway initiation, and 97 patients were enrolled after. Demographics and infection rates were similar between the 2 groups. When urine microscopy was compared to point-of-care urine testing, there were significant reductions in time from urinalysis order to discharge order (median difference of 30 minutes; 95% confidence interval 19 to 42 minutes) and length of stay (median difference of 36 minutes; 95% confidence interval 19 to 55 minutes). There was no treatment delayed because of institution of the point-of-care pathway. Using point-of-care urine testing as an alternative to urine microscopy significantly reduced pediatric ED length of stay and time from urinalysis order to discharge order.