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. 2020 May 28;5(3):e298.
doi: 10.1097/pq9.0000000000000298. eCollection 2020 May-Jun.

Impact of a Standardized Clinical Pathway for Suspected and Confirmed Ileocolic Intussusception

Corinne E Shubin  1 , Lori E Rutman  1 , A Luana Stanescu  2 , Surabhi B Vora  1 , George T Drugas  3 , Michael G Leu  1   4 , Rebekah A Burns  1
Affiliations

Impact of a Standardized Clinical Pathway for Suspected and Confirmed Ileocolic Intussusception

Corinne E Shubin et al. Pediatr Qual Saf. .

Abstract

Introduction: Clinical pathways for specific diagnoses may improve patient outcomes, decrease resource utilization, and diminish costs. This study examines the impact of a clinical pathway for emergency department (ED) care of suspected and confirmed pediatric ileocolic intussusception.

Methods: Our multidisciplinary team designed an intussusception clinical pathway and implemented it in a tertiary children's hospital ED in October 2016. Process measures included the proportion of patients who underwent abdominal radiography, had laboratory studies, received antibiotics, or required admission following reduction of intussusception. The primary outcome measure was the cost per encounter. Balancing measures included unplanned ED visits within 72 hours of discharge. Data analyzed compared 24 months before and 21 months following pathway implementation.

Results: After pathway implementation, the use of abdominal radiography in patients with suspected intussusception decreased from 50% to 12%. In patients with confirmed intussusception, laboratory studies decreased from 58% to 25%, antibiotic use decreased from 100% to 2%, and hospital admissions decreased from 100% to 12%. The average cost per encounter for confirmed intussusception decreased from $6,724 to $2,975. There was a small increase in unplanned returns to the ED within 72 hours but no increase in readmissions after pathway implementation.

Conclusion: Implementation of a standardized ED pathway for the management of suspected and confirmed pediatric ileocolic intussusception is associated with a reduction in abdominal radiographs, improved antibiotic stewardship, reduction in laboratory studies, fewer inpatient admissions, and decreased cost, with no compromise in patient safety.

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Figures

Fig. 1.
Fig. 1.
Key driver diagram for intussusception pathway.
Fig. 2.
Fig. 2.
P-chart for the proportion of patients with suspected intussusception evaluated with abdominal radiographs.
Fig. 3.
Fig. 3.
P-chart for the proportion of patients with confirmed intussusception with any laboratory studies done.
Fig. 4.
Fig. 4.
P-chart for the proportion of patients with confirmed intussusception admitted.
See this image and copyright information in PMC

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