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Implementing a Standardized Constipation-Management Pathway to Reduce Resource Utilization.

David R Sandweiss1, Lauren Allen2, Mark Deneau1

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A new standardized approach significantly reduced unnecessary abdominal radiography and inpatient admissions for pediatric constipation in the emergency department (ED). This quality improvement initiative improved care while lowering costs and resource use.

Keywords:
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Area of Science:

  • Pediatric Emergency Medicine
  • Quality Improvement Science
  • Gastroenterology

Background:

  • Pediatric constipation is a frequent emergency department (ED) diagnosis with highly variable care.
  • Current practices often involve over-reliance on abdominal radiography (AR) and inpatient bowel cleanouts.

Purpose of the Study:

  • To implement and evaluate a standardized quality improvement (QI) pathway for pediatric constipation in the ED.
  • To decrease reliance on AR and inpatient management, promoting standardized home care.

Main Methods:

  • A multidisciplinary team developed an ED constipation management pathway using QI methodology.
  • The pathway emphasized clinical assessment, reduced AR use, and provided standardized home management kits.
  • Outcome measures included AR rates, ED costs, length of stay, and admission rates.

Main Results:

  • Implementation led to a significant decrease in AR rate from 73.3% to 24.6% (P < .001).
  • Average ED cost per patient decreased from $637.42 to $538.85.
  • ED length of stay reduced from 223 to 196 minutes (P < .001), and admission rates dropped from 15.3% to 5.4% (P < .001).
  • No increase in missed diagnoses or ED revisits was observed.

Conclusions:

  • The standardized ED QI project successfully reduced resource utilization for pediatric constipation.
  • The implemented pathway demonstrated sustainable decreases in AR, cost, and length of stay.
  • Future efforts will involve collaboration with community providers to further reduce ED utilization.