Intussusception Protocol Implementation: Single-Site Outcomes With Clinician and Family Satisfaction. J Surg Res 2019 Dec;244:122-129
Date
07/10/2019Pubmed ID
31284141DOI
10.1016/j.jss.2019.06.036Scopus ID
2-s2.0-85068420067 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
BACKGROUND: The objective of this study was to evaluate clinical outcomes, costs, and clinician and parent satisfaction after implementation of a protocol to discharge patients from the emergency department (ED) after successful reduction of uncomplicated ileocolic intussusception.
MATERIALS AND METHODS: In March 2017, an intussusception management protocol was implemented for children presenting with ultrasound findings of ileocolic intussusception. Those meeting inclusion criteria were observed after successful radiological reduction in the ED and discharged after 6 h with resolution of symptoms. Retrospective chart review was completed for cases before and after protocol implementation for clinical outcomes and costs. Clinicians and parents were surveyed to assess overall satisfaction.
RESULTS: Charts were reviewed before (42 encounters, 37 patients) and after (30 encounters, 23 patients) protocol implementation. After implementation, admission rates decreased from 95% (40/42) to 23% (7/30; P < 0.001) and antibiotic use was eliminated (91% to 0%, P < 0.001). There was no difference in recurrence rates (17% versus 23%, P = 0.44). Median total length of stay decreased from 18.87 to 9.52 h (P < 0.001), whereas median ED length of stay increased from 4.37 to 9.87 h (P < 0.001). In addition, there was an overall hospital cost saving of over $2000 ($9595 ± 3424 to $7465 ± 3723; P = 0.009) per encounter. Clinicians and parents were overall satisfied with the protocol and parents showed no changes in patient satisfaction with protocol implementation.
CONCLUSIONS: An intussusception protocol can facilitate early discharge from the ED and improve patient care without increased risk of recurrence. Additional benefits include decreased hospital- and patient-related costs, elimination of antibiotic use, and parent as well as clinician satisfaction.
Author List
McLeod JS, Gavulic AE, Wendt W, Hilu MH, Dunbar E, Macy M, Sroufe N, Perrone EEAuthor
Wendi-Jo Wendt MD Assistant Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Child, PreschoolClinical Protocols
Emergency Service, Hospital
Enema
Female
Health Plan Implementation
Hospital Costs
Humans
Ileal Diseases
Infant
Infant, Newborn
Intussusception
Length of Stay
Male
Patient Discharge
Personal Satisfaction
Program Evaluation
Quality Improvement
Retrospective Studies
Secondary Prevention
Surveys and Questionnaires
