DEVELOPMENT OF CRITERIA LED DISCHARGE FOR UNCOMPLICATED KIDNEY AND URINARY TRACT INFECTIONS: A QUALITY ASSURANCE STUDY OF ADMISSIONS AT CONCORD HOSPITAL OVER A 12 MONTH PERIOD
Dr Thiveya Theivendran1,2, Dr Shaundeep Sen1,2
1Department of Renal Medicine, Concord Repatriation General Hospital, Concord, Australia, 2Faculty of Medicine and Health, University of Sydney, Sydney, Australia
Background: Uncomplicated kidney and urinary tract infections (KID&UTIs) are the second most common cause of preventable hospitalisations. Concord Hospital –an adult tertiary referral centre bordering three local health districts (LHD) has increased length of stay (LOS) in this cohort compared to national averages.
Aim: To identify factors contributing to LOS in uncomplicated KID&UTIs and create a criteria led discharge (CLD) protocol.
Methods: All adults admitted to Concord Hospital with primary diagnosis of uncomplicated KID&UTIs in a 12 month period (2022-23) were included. Patients with complications (urological abnormalities, immunocompromise, CKD stage>/4 or HbA1c >/8%), sepsis, concomitant medical or social issues were excluded.
Results: Of the 30 included patients, 100% were female and functionally independent, with an average age of 37years(σ=16years) and LOS of 2.57days(σ=1.39days). Escherichia coli was the predominant isolate in urine(n=17,57%) and serum(n=2,100%) and demonstrated extended-spectrum beta-lactamase (ESBL) resistance in 5(17%) cases. Renal imaging was performed in 29(97%) patients, ultrasound more common in weekday-in-hours triages (14/15,93%) and CT more common in out-of-hours triages (9/14,64%). Univariate Mann Whitney U analysis demonstrated greater median LOS in patients with bacteremia (3.42vs2.13days,p<0.10) and residence outside local Hospital in the Home (HITH) catchment (2.85vs2.09days,p<0.05). There was a trend towards increased median LOS in patients with ESBL isolate or urine collected after antibiotic administration, however this did not reach statistical significance. The application of a CLD protocol identified 16 patients with potential for reduced LOS, equating to aggregate 18.5days or ~$22,800 annual cost benefit.
Conclusion: In patients admitted for uncomplicated KID&UTIs, LOS is affected by bacteraemia and residence outside local HITH catchment. The application of a CLD protocol and streamlined inter-LHD processes would reduce LOS and improve overall service delivery.
Biography:
Thiveya is a Basic Physician Trainee at Concord Repatriation Hospital with a keen interest in all facets of nephrology and clinical research. In 2023 she presented a case series of ADTKD based at The Tweed Hospital Renal Services, and in 2022 she was awarded the Shaun Summers Clinical Trainee Award for an ANZDATA registry study performed whilst at Westmead Hospital. This year, Thiveya has examined delivery of health services on a local level with an interest for wider quality improvement. Outside of medicine, Thiveya enjoys sharing her love for culinary and outdoor exploration.