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

Area of Science:

• Pediatric Surgery
• Healthcare Quality Improvement
• Clinical Practice Guidelines

Background:

• An evidence-based clinical practice guideline (CPG) was developed and implemented using the plan-do-study-act (PDSA) framework at a tertiary children's center.
• The guideline focused on improving the care of pediatric appendicitis patients.

Purpose of the Study:

• To evaluate the impact of implementing an evidence-based CPG for pediatric appendicitis on clinical outcomes and patient experience.
• To assess the effectiveness of the PDSA framework in guideline development and implementation.

Main Methods:

• Iterative development of an evidence-based CPG for appendicitis using PDSA cycles, adapting existing guidelines.
• Integration of guideline-specific order sets and electronic medical record documentation.
• Tracking of outcomes including length of stay (LOS), 30-day readmissions, costs, and patient and family experience (PFE) scores using Statistical Process Charts.

Main Results:

• Significant reduction in LOS for both simple and complicated appendicitis.
• Average cost savings of $1,122 per patient.
• No change in 30-day readmission rates, but improved patient and family experience scores exceeding national benchmarks.

Conclusions:

• The PDSA framework is effective for developing and implementing CPGs in pediatric appendicitis care.
• Implementation of the CPG added value to patient care within a tertiary setting.
• The guideline successfully improved efficiency and patient satisfaction without compromising safety.