G140(P) Improving the investigation of UTI in a paediatric emergency department. (25th October 2020)

• Record Type: Journal Article
• Authors: Hossack, D; Raja, K
• Is Part Of: Archives of disease in childhood. Volume 105(2020)Supplement 1
• Page Start: A47
• Page End: A47
• Publication Date: 2020-10-25
• Subjects: Children -- Diseases -- Periodicals; Infants -- Diseases -- Periodicals; 618.920005
• DOI: 10.1136/archdischild-2020-rcpch.112
• Languages: English
• ISSNs: 0003-9888

Abstract

Abstract : Aim: Urine sampling is a common investigation in the paediatric emergency department, often requested at triage. We noticed frequent occasions of samples being incorrectly requested and sent for analysis. This often creates unnecessary inconvenience for patients and carers and can delay discharge. There is also potential for misdiagnosis of UTI and antibiotics being unnecessarily prescribed, as well as increased costs. Our aim was to evaluate staff awareness of the correct investigation for paediatric UTI based on the current NICE guideline (February 2019). This was done with the intention of developing clinical practice, in order to improve patient experience, reduce the number of diagnosis errors, and reduce department costs. Method: Twenty-two staff members undertaking paediatric emergency triage were surveyed to check knowledge of the clinical indications for requesting a sample and sending for analysis. An online survey was also carried out to compare our practice with other Trusts. We used The Model for Improvement to test interventions according to errors noted. Results: Only 45% (10/22) of staff were aware of the NICE guideline. 59% (13/22) would request a urine sample from all patients presenting with fever. Furthermore, 55% (12/22) would send all samples for patients under 3 years for urgent analysis, regardless of presenting complaint. This contrasted markedly from our online survey results, which showed 58% (7/12) would send samples in those under 1 year, 8% (1/12) in those less than 6 months, and 25% (3/12) in those less than 3 months (as per NICE guidance). In one Trust doctors did their own urine microscopy based on clinical grounds. Conclusion: The results of our survey show an inadequate level of staff training regarding paediatric urine sampling and analysis, and awareness of the NICE guideline. This results in unnecessary samples being requested and sent for analysis. To increase staff awareness, posters with easy to follow flow-charts have been produced for the triage rooms and training is underway. We also aim to revise hospital guidelines in accordance with NICE guidance. The future intention is to re-survey triage staff following these changes, and evaluate the cost saving of reduced urine analysis.