• Julie Furmick, Chad Scarboro, Michael Runyon, and John Manning.
• Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, NC. Electronic address: jfurmick@phoenixchildrens.com.
• Ann Emerg Med. 2022 Mar 1; 79 (3): 270-278.

Study ObjectivePoint-of-care urine testing is an alternative to urine microscopy in children. However, it remains unclear if utilizing point-of-care urine testing without urine microscopy decreases length of stay in the emergency department (ED). We implemented a point-of-care-driven urinary tract infection management pathway to evaluate effects on length of stay.MethodsThis was an uncontrolled before and after study examining a point-of-care urinalysis pathway in a children's ED. We obtained preliminary data by prospectively evaluating urine microscopy. We then implemented a pathway in which point-of-care urine testing determined treatment and disposition. Outcomes included time from urinalysis order to discharge order, length of stay, and rate of delayed treatment.ResultsA total of 118 patients were enrolled before pathway initiation, and 97 patients were enrolled after. Demographics and infection rates were similar between the 2 groups. When urine microscopy was compared to point-of-care urine testing, there were significant reductions in time from urinalysis order to discharge order (median difference of 30 minutes; 95% confidence interval 19 to 42 minutes) and length of stay (median difference of 36 minutes; 95% confidence interval 19 to 55 minutes). There was no treatment delayed because of institution of the point-of-care pathway.ConclusionUsing point-of-care urine testing as an alternative to urine microscopy significantly reduced pediatric ED length of stay and time from urinalysis order to discharge order.Copyright © 2021 American College of Emergency Physicians. Published by Elsevier Inc. All rights reserved.

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