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. 2019 Oct;42(sup1):205-214.
doi: 10.1080/10790268.2019.1647928.

Conception and development of Urinary Tract Infection indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

B Catharine Craven  1   2   3 , S Mohammad Alavinia  1   2 , Jerzy B Gajewski  4 , Raj Parmar  5 , Sandi Disher  3 , Karen Ethans  6 , John Shepherd  1   7 , Maryam Omidvar  1 , Farnoosh Farahani  1 , Magdy Hassouna  8   9 , Blayne Welk  10
Affiliations

Conception and development of Urinary Tract Infection indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project

B Catharine Craven et al. J Spinal Cord Med. 2019 Oct.

Abstract

Context: Urinary tract infections (UTI) are the most frequent secondary health condition following spinal cord injury or disease (SCI/D) that adversely impact overall health and quality of life, and often result in rehabilitation service interruptions, emergency department visits, and urinary sepsis. Methods: Experts in Urohealth and/or UTI recognition and management and the SCI-High Project Team used a combination of evidence synthesis and consensus methods for developing the UTI indicators. A systematic search and a Driver diagram analysis were applied to identify key factors influencing UTI. This Driver diagram guided the UTI Working Group when defining the construct, specifying the aim for the UTI SCI/D quality indicators, and developing the UTI diagnostic checklist and fever definition. Results: The structure indicator was the proportion of patients with a health care professional (i.e. family physician or urologist) able to follow-up with the patient regarding urine culture and sensitivity results within 48-72 h of collection. The Working Group knowingly adopted a single checklist for UTI diagnosis, recognizing the stark contrast in the complexity of diagnosis in acute versus community settings. The process indicator is the proportion of SCI/D rehabilitation inpatients with UTI as defined by the UTI diagnostic checklist. The outcome indicator is the proportion of SCI/D rehabilitation inpatients with inappropriate antibiotic prescription. Conclusion: UTI can be diagnosed using the developed symptoms and signs checklist. These structure, process, and outcome quality indicators will ultimately reduce inappropriate antibiotic therapy for UTI and the rising incidence of antibiotic resistance among community-dwelling individuals with chronic SCI/D.

Keywords: Healthcare quality indicator; Rehabilitation; Spinal cord injuries; Urinary tract infection.

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Figures

Figure 1
Figure 1
Driver diagram for the Urinary Tract Infection Domain. Boxes and letters in red represent the most feasible branches for indicator development according to the opinion of the Domain-specific Working Group. An individual's impairments, including their neurological level and completeness of injury, and degree of motor, sensory and autonomic dysfunction impact their NLUTD and the frequency and severity of UTI. UEMS: Upper-extremity motor score, LEMS: lower-extremity motor score, NLI: neurological level of injury, AIS: ASIA Impairment Scale; HR: heart rate, BP: blood pressure, PT: physiotherapist, OT: occupational therapist, MD: medical doctor.
Figure 2
Figure 2
SCI-High Urinary Tract Infection Diagnostic Checklist.
Figure 3
Figure 3
SCI-High Urinary Tract Infection management and treatment diagram.
See this image and copyright information in PMC

References

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