A Quality Improvement Project to Improve Management of Urinary Tract Infections in a System of Pediatric Urgent Care Centers

Background and objective: Urinary tract infections (UTIs) are a common problem in pediatric urgent care medicine. There are multiple quality improvement (QI) projects related to the management of UTIs documented in the pediatric literature. We developed a project to decrease the prescribing of ultimately unneeded antibiotics for possible UTIs in a pediatric urgent care setting. A similar project has not been described in the pediatric literature. Methods: We first reviewed the charts of patients presenting to a system of pediatric urgent care centers with a possible UTI over a 2-year period. We then launched a QI project with three plan, do, study, act cycles to decrease the prescribing of antibiotics for patients who ultimately were found to not have a UTI based on urine culture results. We tracked the number of patients who needed to be started on antibiotics after their urgent care visit a balancing measure, and also tracked multiple secondary measures throughout the project. Balancing measures are tracked to make sure that unintended negative consequences do not occur from a QI project. In this case, the concern was that patients who should have been started on antibiotics for a UTI may have had a delay in care because of the project. Results: The absolute percentage of antibiotics prescribed that were ultimately unneeded decreased by an absolute 15% during the project, and met special cause variation criteria. There was no special cause variation noted for our balancing measure. All of our secondary measures showed improvement during the project. Conclusions: A large-scale QI project at a system of pediatric urgent care centers was able to decrease the unneeded prescription of antibiotics for possible UTIs