Decreased ER visits and readmissions after implementation of a standardized perioperative toolkit for children with
Scott S Short1, Michael D Rollins1, Sarah Zobell1
1Department of Surgery, Division of Pediatric Surgery, and Primary Children's Hospital, University of Utah, 100N. Mario Capecchi Drive, Suite 3800, Salt Lake City, UT 84108, United States.
Insights
A dedicated pediatric inflammatory bowel disease (IBD) clinic reduced emergency visits and readmissions after surgery. This multidisciplinary approach improved outcomes for children with IBD.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes
- Healthcare Management
Background:
- Pediatric inflammatory bowel disease (IBD) presents significant morbidity, often necessitating extensive medical and surgical interventions.
- Evaluating the impact of specialized care models is crucial for improving outcomes in pediatric IBD management.
Purpose of the Study:
- To assess the effect of a dedicated multidisciplinary clinic on the outcomes of pediatric patients with IBD undergoing abdominal surgery.
- To determine if the implementation of specific care protocols and resources influences post-operative outcomes.
Main Methods:
- Retrospective review of a prospective database of children undergoing abdominal operations for IBD.
- Comparison of outcomes for patients managed before and after the establishment of a multidisciplinary clinic.
- Analysis of primary outcomes including return to operating room, length of stay, 30-day ER visits, and 30-day readmissions.
Main Results:
- 41 children underwent 80 major abdominal operations, with similar disease distribution and severity across periods.
- A statistically significant decrease in emergency room visits within 30 days of surgery was observed (9.3% vs. 27%, p=0.04).
- Hospital readmissions within 30 days of surgery also significantly decreased (2.3% vs. 24.3%, p=0.005).
Conclusions:
- The establishment of a dedicated multidisciplinary clinic for pediatric IBD is associated with improved post-operative care.
- Focus on standardized protocols and integrated resources within the clinic setting led to reduced emergency department visits and hospital readmissions.
- This model of care demonstrates a positive impact on reducing short-term complications following surgery in children with IBD.
Background:
Pediatric inflammatory bowel disease (IBD) carries significant morbidity and requires extensive medical and often surgical intervention. The aim of this study was to evaluate the impact of a dedicated Multidisciplinary clinic on the outcomes of children with IBD.
Methods:
A retrospective review of a prospective database, established to track quality and outcomes of children undergoing an abdominal operation for IBD, was performed. Children who were managed before (09/2017-03/2019) and after (04/2019-06/2020) establishment of the multidisciplinary clinic were examined. The clinic instituted several care process protocols including early recovery (ERAS) and garnered additional resources for patients (wound ostomy, nutrition, social work, etc.) Primary outcomes were unanticipated return to the operating room, length of stay, ER visits within 30 days of surgery and hospital readmissions within 30 days of surgery.
Results:
We identified 41 children who underwent a total of 80 major abdominal operations; 46.3% of procedures occurred before and 53.7% occurred after instituting our clinic. There were no notable changes in disease distribution (e.g., ulcerative colitis vs. Crohn's), disease severity, medication exposure, or case urgency (elective vs. emergent). ER visits within 30 days of surgery decreased (4 (9.3%) vs. 10 (27%), p = 0.04) as did readmissions within 30 days of surgery (1 (2.3%) vs. 9 (24.3%), p = 0.005).
Conclusions:
Implementation of a dedicated multidisciplinary clinic for IBD and its attendant focus on protocols and appropriate use of adjunctive resources was associated with decreased emergency department visits and hospital readmissions in the post-operative setting.
Level Of Evidence:
III.
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