Staged urine collection from triage in young children with suspicion of UTI

Drs. Lindsey Chaudoin, Morgan Penzler

Background: In younger children, urinary tract infections (UTIs) often present with nonspecific symptoms and require urine collection to help diagnose or exclude UTI as an etiology for fever. While bladder catheterization has the lowest contamination rate when considering options for urine collection, it can be uncomfortable and resource intensive. Studies have shown that urine bag placement in triage for a specific patient population can assist in decreasing catheterization rates in young, febrile children without causing an increased length of stay or change in culture positivity rate. A negative urine dip from a urine bag specimen has been shown to be a reliable method for excluding UTI, and may be an effective way to decrease catheterization rates when used as a screening test.

Objectives: To establish a baseline population of patients that may benefit from use of urine bag placement in triage to decrease catheterization rates, not miss UTIs, and shorten throughput in our pediatric emergency department.

Methods: A three-month baseline data set was obtained to look at the total number of patients who met our inclusion criteria. We obtained data regarding patient demographics, the number of urine samples taken, urine sample results, number of catheterizations, number of positive cultures, emergency department length of stay, and return visits within 72 hours.

Results: 119 pediatric patients were identified within our timeframe who met all inclusion and exclusion criteria. Of these patients, 84.8% were screened for UTI, with a 4.5% culture positivity rate. 44.6% of patients had a urethral catheterization ordered to obtain a urine sample. None of the patients with a documented 72-hour return had a missed UTI. The average length of stay for these patients was 355 minutes, with an average of 276 minutes from initial provider contact to discharge.

Discussion/Next Steps: We identified a pediatric patient population who may benefit from implementation of placement of a urine bag in triage. We have initiated our PDSA cycles and will continue to gather data for a total of six months. We will use a p-chart, a type of statistical process control chart using the binomial distribution, to assess the impact of improvement effort after our interventions.

Financial literacy amongst emergency physicians and emergency medicine trainees in an academic center

Eric Sabatini-Regueira, MD; Michael Runyon, MD

Objectives: To assess emergency medicine residents, fellows, and attending physicians financial literacy and current financial situation, and compare to previously published data of a group of similarly educated individuals

Methods: A cross-sectional, anonymous, web-based survey was administered to a convenience sample of emergency medicine residents, fellows, and attending physicians at a single large academic medical center. Informed consent was obtained from the respondents prior to data collection. Respondents were asked to answer the questionnaire used by Ahmad et al in 2015. The questionnaire consists of 20 questions on financial knowledge and 31 questions about their own financial planning, spending behaviors, debt, and demographics. Questions regarding risk-tolerance and one’s financial condition were graded using a Likert scale, 1 being the lowest score and 10 being the highest.

Results: 107 physicians were invited to participate, of which 42 responded to the survey; of the total of respondents, 20 (47.6%) were residents. The median age of the respondents was 33.5 years. The average score in the financial knowledge quiz was 61.15%, with a standard deviation of 3.78; when considering only residents – the average score was 54% (SD = 3.88). The mean satisfaction with the respondent’s financial situation was 5.2 (SD = 2.44) for residents and 6.07 (SD = 2.4) for the global study population. Residents had a mean risk tolerance of 4.85 (SD = 2.68), 5.69 (SD = 2.36) for the global study population. 4.76% of respondents have no retirement savings; and of those who have any, 21.4% have less than $25,000. 9.52% of the physicians carry over high interest debt in the form of credit card debt. Of the respondents, 45.23% currently have student debt and 54.76% currently owe in the form of a mortgage. Higher scores on the financial knowledge quiz were weakly correlated with higher risk tolerance (r=0.43, p = 0.004) and not correlated with satisfaction about one’s financial situation (r=0.2, p = 0.199).

Conclusions: Emergency medicine residents, fellows, and attending physicians at a single hospital within the Atrium Health system have low financial literacy. The overall risk tolerance is low and the individual debt is high. Most survey respondents are not satisfied with their current financial situation. In this highly educated cohort, parent’s educational background is not associated with an individual’s financial literacy level. Our results are, in part, similar to those of a previously published cohort of similarly educated individuals.

Outcome and Process Characteristics of nerve blocks using ultrasound guidance for regional anesthesia performed by EM physicians at a quaternary, regional ED

Elzada Sercus MD, Denise Fraga MD, Vivek Tayal MD

Carolinas Medical Center, Department of Emergency Medicine, Charlotte, NC

Objective: This study characterized types of nerve blocks performed by emergency physicians (EP) at a single level 1 academic emergency department, common indications for these blocks, rates of success and complications of these blocks, and patient and provider satisfaction of the blocks.

Method: Single center, retrospective observational quality improvement (QI) study using a convenience sample at an urban academic trauma center over a 5-year period. Data was collected on nerve blocks performed from December 2017 through December 2022. Providers filled out data collection sheets containing patient demographics; type of block; indication for each block; pre and post block pain scale; anesthetic agent and dose; number of attempts; complications; whether block was successful; patient and provider satisfaction scores; and the proceduralist’s level of training.

Results: There were 199 nerve blocks performed on 192 individual patients. The most frequently performed blocks were the fascia iliaca compartment block (FICB) (50.75%) and erector spinae plane (ESP) blocks (24.12%). Most blocks were performed by PGY2 (15.9%) and PGY3 (23.1%) residents. About 74.4% of blocks were performed in a single attempt and 8.7% of blocks required a second attempt. Most blocks were considered successful (72.8%), 4.6% were unsuccessful, and 22.6% were neither marked as being successful or unsuccessful. Only one block (0.5%) resulted in a complication. On a scale of 1-5, average patient satisfaction was 4.62 (SD=0.696) and average provider satisfaction was 4.56 (SD=0.744).

Conclusion: We characterize the various US guided nerve blocks performed by the EPs at our institution along with the common indications for these blocks. In those blocks that were able to be followed, we were able to demonstrate that these blocks can be performed safely and successfully with high physician and patient satisfaction and nearly no complications.