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. 2021 Jul 28;6(4):e442.
doi: 10.1097/pq9.0000000000000442. eCollection 2021 Jul-Aug.

Implementing PDSA Methodology for Pediatric Appendicitis Increases Care Value for a Tertiary Children's Hospital

Martha-Conley E Ingram  1 , Abbey Studer  1 , Jamie Schechter  1 , Sarah A Martin  1 , Manisha Patel  1 , Emily C Z Roben  1 , Nicholas E Burjek  1 , Patrick K Birmingham  1 , Mehul V Raval  1
Affiliations

Implementing PDSA Methodology for Pediatric Appendicitis Increases Care Value for a Tertiary Children's Hospital

Martha-Conley E Ingram et al. Pediatr Qual Saf. .

Abstract

Introduction: We used the plan-do-study-act (PDSA) framework to develop and implement an evidence-based clinical practice guideline (CPG) within an urban, tertiary children's referral center.

Methods: We developed an evidence-based CPG for appendicitis using iterative PDSA cycles. Similar CPGs from other centers were reviewed and modified for local implementation. Adjuncts included guideline-specific order sets and operative notes in the electronic medical record system. Outcomes included length of stay (LOS), 30-day readmissions, hospital costs, and patient and family experience (PFE) scores. Our team tracked outcome, process, and balancing measures using Statistical Process Charts. Outcome measures were compared over 2 fiscal quarters preimplementation and 3 fiscal quarters postimplementation, using interrupted time series, student t test, and chi-square tests when appropriate.

Results: LOS for simple (uncomplicated) appendicitis decreased to 0.87 days (interquartile range [IQR] 0.87-0.94 days) from 1.1 days (IQR 0.97-1.42 days). LOS for complicated appendicitis decreased to 4.96 days (IQR 4.95-6.15) from 5.58 days (IQR 5.16-6.09). This reduction equated to an average cost-savings of $1,122/patient. Thirty-day readmission rates have remained unchanged. PFE scores increased across all categories and have remained higher than national benchmarks.

Conclusion: Development and Implementation of a CPG for pediatric appendicitis using the PDSA framework adds value to care provided within a large tertiary center.

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Figures

Fig. 1.
Fig. 1.
Key driver diagram used to identify causes and drivers for the LOS after appendectomy. ED, emergency department; OR, operating room; SOW, surgeon of the week; SSI, superficial site infection.
Fig. 2.
Fig. 2.
LOS for simple appendicitis, by fiscal quarter.
Fig. 3.
Fig. 3.
Interrupted time series analysis for LOS for simple appendicitis, pre- and post-CPG implementation.
Fig. 4.
Fig. 4.
LOS for complicated appendicitis, by fiscal quarter.
See this image and copyright information in PMC

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