Abstract

Aim: The European Association of Urology (EAU) defines management for patients with suspected pyelonephritis (SP), including renal tract ultrasound scan (USS). Patients are often admitted despite risks of hospitalisation. Our aim is to define safe criteria for patients to be managed using a “suspected acute pyelonephritis ambulatory (SAPA) pathway”. Methods: A closed loop quality improvement project was undertaken starting with a baseline audit of all patients with SP over two months in 2017. Fifty patients discharged within 24 hours of admission were found to have six defining characteristics, forming inclusion criteria for our SAPA pathway. Trial of the SAPA pathway began after staff education. Pathway patients follow a specific ambulatory management pathway, ending in same-day discharge with USS and Urology review the following day. Outcomes of SAPA pathway patients were then prospectively audited. Results: 73 patients have been managed via this SAPA pathway so far. 0 patients have required further admission following review the following day. 30-day readmission is 0%. No patients have been found to have renal tract obstruction on USS. Conclusion: This closed loop audit proves that patients can be safely managed through an ambulatory pathway. More study is required to expand inclusion criteria for this bed-saving pathway.