title: Process Mapping in a Pediatric Emergency Department to Minimize Missed Urinary Tract Infections.
abstract: Urinary tract infections (UTIs) are common in young children and are seen in emergency departments (EDs) frequently. Left untreated, UTIs can lead to more severe conditions. Our goal was to undertake a quality improvement (QI) initiative to help minimize the number of children with missed UTIs in a newly established tertiary care pediatric emergency department (PED). A retrospective chart review was undertaken to identify missed UTIs in children < 3 years old who presented to a children's hospital's ED with positive urine cultures. It was found that there was no treatment or follow-up in 12% of positive urine cultures, indicating a missed or possible missed UTI in a significant number of children. Key stakeholders were then gathered and process mapping (PM) was completed, where gaps and barriers were identified and interventions were subsequently implemented. A follow-up chart review was completed to assess the impact of PM in reducing the number of missed UTIs. Following PM and its implementation within the ED, there was no treatment or follow-up in only 1% of cases. Based on our results, the number of potentially missed UTIs in the ED decreased dramatically, indicating that PM can be a successful QI tool in an acute care pediatric setting.
authors.affiliation: McMaster Family Practice, Department of Family Medicine, McMaster University, 3rd Floor, 100 Main St. W., Hamilton, ON, Canada L8P 1H6.
authors.forename: Morgan
authors.identifier: 0000-0003-1499-4854
authors.initials: M
authors.lastname: Black
authors.affiliation: University of Toronto Faculty of Medicine, 1 King's College Cir No. 3172, Toronto, ON, Canada M5S 1A8.
authors.forename: Valene
authors.initials: V
authors.lastname: Singh
authors.affiliation: Division of Pediatric Nephrology, McMaster Children's Hospital, 1280 Main Street West, Room 3A, Hamilton, ON, Canada L8S 4K1.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Belostotsky
authors.affiliation: Division of General Pediatrics, McMaster Children's Hospital, 1280 Main Street West, Room 3A, Hamilton, ON, Canada L8S 4K1.
authors.forename: Madan
authors.initials: M
authors.lastname: Roy
authors.affiliation: Division of Medical Microbiology, Hamilton General Hospital, Room W-1, I-90, 237 Barton St. East, Hamilton, ON, Canada L8L 2X2.
authors.forename: Deborah
authors.initials: D
authors.lastname: Yamamura
authors.affiliation: Division of General Pediatrics, McMaster Children's Hospital, 1280 Main Street West, Room 3A, Hamilton, ON, Canada L8S 4K1.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Gambarotto
authors.affiliation: The University of Hong Kong-Shenzhen Hospital, 1 Haiyuan 1st Road, Futian District, Shenzhen, Guangdong 518053, China.
authors.forename: Keith
authors.initials: K
authors.lastname: Lau
authors.affiliation: Division of Pediatric Emergency Medicine, McMaster Children's Hospital, 1280 Main Street West, Room 2N49, Hamilton, ON, Canada L8S 4K1.
authors.forename: April J
authors.identifier: 0000-0002-9977-0966
authors.initials: AJ
authors.lastname: Kam