Mehul V Raval1, Peter C Minneci2, Katherine J Deans2, Kelli J Kurtovic3, Ann Dietrich4, D Gregory Bates5, Shawn J Rangel6, R Lawrence Moss2, Brian D Kenney2. 1. Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia; mehulvraval@emory.edu. 2. Division of Pediatric Surgery, Department of Surgery, and. 3. Quality Improvement Services, Nationwide Children's Hospital, Columbus, Ohio; 4. Ohio University College of Medicine, Athens, Ohio; and. 5. Department of Radiology, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio; 6. Division of Pediatric Surgery, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Abstract
OBJECTIVES: The purpose of this project was to implement a protocol facilitating discharge from the emergency department (ED) after successful radiologic ileocolic intussusception reduction in a pediatric referral center. METHODS: A multidisciplinary team identified drivers for successful quality improvement including educational brochures, a standardized radiologic report, an observation period in the ER with oral hydration challenges, and follow-up phone calls the day after discharge. Patient outcomes were tracked, and quarterly feedback was provided. RESULTS: Of 80 patients identified over a 24-month period, 34 (42.5%) did not qualify for discharge home due to need for surgical intervention (n = 9), specific radiologic findings (n = 11), need for additional intravenous hydration (n = 4), or other reasons (n = 7). Of 46 patients who qualified for discharge, 30 (65.2%) were successfully sent home from the ED. One patient returned with recurrent symptoms that required repeat enema reduction. Sixteen patients were observed and discharged within 23 hours. Adherence with discharge from the ED improved over time. Discharge from the ED was associated with cost savings and improved net margins at the hospital level for each encounter. CONCLUSIONS: A sustainable multidisciplinary quality improvement project to discharge intussusception patients from the ED after air-contrast enema reduction was successfully integrated in a high-volume referral center through education, standardized radiologic reporting, and protocoled follow-up.
OBJECTIVES: The purpose of this project was to implement a protocol facilitating discharge from the emergency department (ED) after successful radiologic ileocolic intussusception reduction in a pediatric referral center. METHODS: A multidisciplinary team identified drivers for successful quality improvement including educational brochures, a standardized radiologic report, an observation period in the ER with oral hydration challenges, and follow-up phone calls the day after discharge. Patient outcomes were tracked, and quarterly feedback was provided. RESULTS: Of 80 patients identified over a 24-month period, 34 (42.5%) did not qualify for discharge home due to need for surgical intervention (n = 9), specific radiologic findings (n = 11), need for additional intravenous hydration (n = 4), or other reasons (n = 7). Of 46 patients who qualified for discharge, 30 (65.2%) were successfully sent home from the ED. One patient returned with recurrent symptoms that required repeat enema reduction. Sixteen patients were observed and discharged within 23 hours. Adherence with discharge from the ED improved over time. Discharge from the ED was associated with cost savings and improved net margins at the hospital level for each encounter. CONCLUSIONS: A sustainable multidisciplinary quality improvement project to discharge intussusception patients from the ED after air-contrast enema reduction was successfully integrated in a high-volume referral center through education, standardized radiologic reporting, and protocoled follow-up.
Authors: Corinne E Shubin; Lori E Rutman; A Luana Stanescu; Surabhi B Vora; George T Drugas; Michael G Leu; Rebekah A Burns Journal: Pediatr Qual Saf Date: 2020-05-28
Authors: Lorraine I Kelley-Quon; L Grier Arthur; Regan F Williams; Adam B Goldin; Shawn D St Peter; Alana L Beres; Yue-Yung Hu; Elizabeth J Renaud; Robert Ricca; Mark B Slidell; Amy Taylor; Caitlin A Smith; Doug Miniati; Juan E Sola; Patricia Valusek; Loren Berman; Mehul V Raval; Ankush Gosain; Matthew B Dellinger; Stig Sømme; Cynthia D Downard; Jarod P McAteer; Akemi Kawaguchi Journal: J Pediatr Surg Date: 2020-10-06 Impact factor: 2.545
Authors: Alexander V Chalphin; Stephanie K Serres; Rosella A Micalizzi; Michele Dawson; Caitlin Phinney; Angelique Hrycko; Ariel Martin-Quashie; Michael J Pepin; Charles J Smithers; Shawn J Rangel; Catherine Chen Journal: Pediatr Qual Saf Date: 2019-08-30