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289 Development of a decision-making flowchart to improve the ongoing management and follow-up of children with urinary tract infections
  1. Rhiannon Hoggins,
  2. Sarah Mills,
  3. Fiona Hignett
  1. Poole Hospital

Abstract

Objectives Many children have urine samples obtained as part of their diagnosis and management. In children aged less than 2 years with a febrile illness, the prevalence of urinary tract infections (UTIs) is approximately 5%, with associated morbidity and mortality.1 There is associated risk of meningitis (in neonates), and potential for renal injury and scarring.1 Consequently, interpretation of urine microscopy and culture (MC&S) is an important task encountered by clinicians working in paediatrics, including organising appropriate follow-up and imaging.

Methods Surveys were sent out to clinicians who are involved in interpreting urine MC&S and organising follow-up. Assessment was made of their previous knowledge and confidence in this area and whether they had previously received any appropriate teaching. A decision-making flowchart was developed based on the current NICE guidelines (figure 1).2 A teaching session was delivered to clinicians surrounding the aetiology, prevalence and management of UTIs. The flowchart was then introduced to clinicians and its efficacy was assessed alongside common clinical scenarios. Post-intervention questionnaires were distributed to evaluate the decision-making flowchart further and to assess clinician’s confidence in UTI management.

Results 15 respondents (foundation doctors (4), paediatric trainees (5), GP trainees (1) physician associates (2) and medical students (2)) completed the initial questionnaire. 67% of respondents reported having to interpret urine MC&S samples multiple times per week. Staff self-rated their confidence interpreting samples at a median score of 7/10 however, when asked how confident they felt in arranging follow-up the median score was 3/10. Participants reported using a variety of resources to support their decision-making including NICE and regional guidelines, or seeking advice from a senior colleague. 93.3% of respondents had not received any formal teaching surrounding the management of UTIs, interpretation of results and appropriate follow-up. Following delivery of the teaching session the median confidence score had increased to 8/10 in both categories.

Conclusions Urine sample interpretation and follow-up is a common task for junior clinicians however, many do not receive formal teaching surrounding this leading to confusion and a lack of confidence. We have developed a UTI interpretation framework, alongside a teaching session based on NICE guidelines. Overall, participants felt that the decision-aid was simple to follow and summarised the information required. They felt that this would save time and ensure investigations are not missed, contributing to improved patient care. When assessing the intervention in clinical scenarios, it was shown to generate the correct responses for ongoing management.

References

  1. Butler C, O’Brien K, Pickles T, et al. (2015) Childhood urinary tract infection in primary care: a prospective observational study of prevalence, diagnosis, treatment, and recovery. Br J Gen Pract 65.

  2. Urinary tract infection in under 16s: diagnosis and management. NICE Guideline. July 2022.

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