STANDARDIZATION OF URINARY CATHETERIZATION GUIDELINES TO REDUCE PAEDIATRIC PERIOPERATIVE URINARY TRACT INFECTION RATES: A QUALITY IMPROVEMENT INITIATIVE
Bibliographic record
Abstract
According to the Canadian Patient Safety Institute nosocomial urinary tract infections (UTIs) are the fourth leading cause of healthcare associated infections1. 80% of these are attributable to indwelling urethral catheters2. Nosocomial infections have been shown to often be preventable as well as negatively impact patient outcomes and healthcare costs3,4. As per the Canadian Institute for Health Information the cost of a UTI can range from $3,444 to $5,377 and the average length of stay increases by 3.4 to 5.3 days. Specific to paediatric nosocomial UTIs, increased rates of readmission and reoperation have been demonstrated5. The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) – Paediatric semi-annual reports demonstrated consistently elevated paediatric UTI rates in our institution's paediatric surgical program, with an odds ratio of 1.9x compared to the predicted rate. The purpose of the quality improvement initiative was to reduce the rate of paediatric perioperative UTIs at our institution, with a specific project aim of achieving a 30% reduction in paediatric perioperative UTIs within 1 year of program initiation. A multidisciplinary working group was formed, with broad stakeholder involvement. Audits were performed to assess current perioperative catheterization practices and identify areas for improvement. A ‘permissive list’ was developed of paediatric surgical procedures for which catheters may be required. Consensus was achieved to standardize early urinary catheter removal except for urologic procedures. Educational campaigns focused on proper catheter insertion and maintenance techniques were developed. Standardization of urinary catheterization equipment, technique and maintenance was achieved. Electronic Medical Record order sets were developed to implement the above as a standardized ‘forcing function’. Project implementation was delayed due to the COVID-19 pandemic and secondary changes to elective surgery, leading to a two year project duration. By project completion, a 47% reduction in perioperative UTI rate was achieved. Additionally, 96% adherence to the ‘permissive lists’ was seen. Performance in the NSQIP-Paediatric program improved from ‘Needs Improvement’ to ‘Exemplary’ Status. Standardization of urinary catheterization indications, management and removal helped achieve a substantial decrease in UTI rates at a tertiary care Children's Hospital across all paediatric surgical services. The involvement of a diverse multidisciplinary team and broad stakeholder engagement helped achieve early buy-in to interventions. The use of forcing functions helped promote consistent early discontinuation of urinary catheters.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".