Non-invasive urinary tract infection screening for young infants: A high-value care initiative

Our aim was to safely decrease unnecessary invasive urinary catheterizations in infants 90 days to <6 months of age by 50% over 24 months in our emergency department without unintended consequences. A multi-professional study team was established, and key stakeholders engaged. Using the Model for Improvement, we implemented a modified 2-step urine bag urinary tract infection (UTI) screening pathway along with reminders and education as our main change ideas. The mean catheterization rate decreased from a baseline of 62.5% to 43.9% during the intervention period, demonstrating special cause variation. Urine cultures also decreased from a mean of 64.7% to 47.3% with special cause variation. There was no increase in length of stay or return visits. There was one potential missed UTI (1/843 patients). Overall, a 2-step non-invasive urine bag UTI screening pathway can be successfully and safely used in the emergency department for young infants aged 90 days and older to improve resource allocation.