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Impact of a Standardized Clinical Pathway for Suspected and Confirmed Ileocolic Intussusception
Corinne E Shubin1, Lori E Rutman1, A Luana Stanescu2
1Department of Pediatrics, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Wash.
Insights
A new clinical pathway for pediatric intussusception in the emergency department significantly reduced imaging, lab tests, antibiotic use, and hospital admissions, leading to lower costs without compromising patient safety.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Pathway Development
- Healthcare Management
Background:
- Clinical pathways can enhance patient outcomes and reduce healthcare costs.
- This study evaluated a clinical pathway for pediatric ileocolic intussusception in the emergency department (ED).
Purpose of the Study:
- To assess the impact of a standardized clinical pathway on the management of pediatric ileocolic intussusception.
- To evaluate changes in resource utilization, cost, and patient safety following pathway implementation.
Main Methods:
- A multidisciplinary team designed and implemented an intussusception clinical pathway in a tertiary children's hospital ED.
- Data were collected for 24 months pre-implementation and 21 months post-implementation, analyzing process measures and cost per encounter.
Main Results:
- Post-implementation, abdominal radiography use decreased from 50% to 12% for suspected cases.
- For confirmed intussusception, laboratory studies fell from 58% to 25%, antibiotic use from 100% to 2%, and admissions from 100% to 12%.
- The average cost per encounter for confirmed intussusception decreased from $6,724 to $2,975.
Conclusions:
- A standardized ED pathway for pediatric intussusception effectively reduced diagnostic tests, antibiotic use, and admissions.
- The pathway led to significant cost savings without negatively impacting patient safety, evidenced by no increase in readmissions.
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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