Process Mapping in a Pediatric Emergency Department to Minimize Missed Urinary Tract Infections
Process Mapping in a Pediatric Emergency Department to Minimize Missed Urinary Tract Infections
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DOI：
10.1155/2016/2625870
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发表时间：
2016-01-01
影响因子：
2.1
通讯作者：
Kam, April J.
中科院分区：
文献类型：
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作者：
Black, Morgan;Singh, Valene;Kam, April J.
尿路感染 (UTI) 在幼儿中很常见，并且经常出现在急诊室 (ED)。如果不及时治疗，尿路感染可能会导致更严重的病症。我们的目标是实施质量改进 (QI) 举措，以帮助最大限度地减少新成立的三级护理儿科急诊科 (PED) 漏诊尿路感染的儿童数量。我们进行了一项回顾性图表审查，以识别在儿童医院急诊科就诊且尿液培养呈阳性的 3 岁以下儿童中遗漏的尿路感染。研究发现，12% 的尿培养阳性患者没有接受治疗或随访，这表明有相当多的儿童漏检或可能漏检尿路感染。然后聚集主要利益相关者并完成流程图（PM），找出差距和障碍并随后实施干预措施。后续图表审查已完成，以评估 PM 在减少漏诊尿路感染数量方面的影响。在急诊室实施 PM 后，只有 1% 的病例没有得到治疗或随访。根据我们的结果，急诊室中可能漏诊的尿路感染数量急剧下降，这表明 PM 可以成为儿科急症护理环境中的一种成功的 QI 工具。
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 identifymissed 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.