Improving a Urine Culture Callback Follow-up System in a Pediatric Emergency Department

Introduction: 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. Method: 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). Discussion: 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.