title: Improving a Urine Culture Callback Follow-up System in a Pediatric Emergency Department.
abstract: BACKGROUND
  Delays in appropriate treatment and unnecessary antibiotic use for urinary tract infections (UTIs) increase the risk for serious adverse events and the potential for antibiotic resistance. The purposes of this quality improvement project were to decrease emergency department laboratory result follow-up time and increase the number of patients who are notified to stop taking an empiric antibiotic.
  
  
  METHODS
  Nine months of Plan-Do-Study-Act (PDSA) cycles were implemented in a pediatric emergency department and network of care sites. Three months of baseline data were compared with 3 months of postinvention data using t-tests and odds ratios.
  
  
  RESULTS
  Time to patient/family laboratory follow-up was reduced from 20.1 hours to 7.1 hours, demonstrating a 64.7% reduction in time to follow-up (p < .01). The percentage of patients who received follow-up notification of negative urine cultures and were told to discontinue antibiotic therapy increased from 8.8% to 74.4% (p < .001).
  
  
  CONCLUSIONS
  Implementation of a culture callback system, staffed by advanced practice providers, led to a significant reduction in the amount of time to follow-up and increased the number of follow-up calls to discontinue antibiotics when urine cultures were negative.
authors.forename: Patrick
authors.initials: P
authors.lastname: Burchett
authors.forename: Scott
authors.initials: S
authors.lastname: Harpin
authors.forename: Ann
authors.initials: A
authors.lastname: Petersen-Smith
authors.forename: Kathryn
authors.initials: K
authors.lastname: Emery
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques; D004334:Drug Administration Schedule; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005500:Follow-Up Studies; D006801:Humans; D058996:Quality Improvement; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013997:Time Factors; D014552:Urinary Tract Infections / Q000188:drug therapy / Q000652:urine*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Pediatrics; emergency medicine; quality improvement; urinary tract infection