A QI Partnership to Decrease CT Use for Pediatric Appendicitis in the Community Hospital Setting

Area of Science:

• Pediatric Emergency Medicine
• Quality Improvement Science
• Diagnostic Imaging Optimization

Background:

• Computerized tomography (CT) is frequently used for pediatric appendicitis evaluation in community general emergency departments (GEDs).
• High CT utilization raises concerns regarding radiation exposure and cost in pediatric patients.

Purpose of the Study:

• To decrease the utilization of CT scans in the evaluation of pediatric appendicitis within a community general emergency department (GED) system by 50% within one year.
• To implement and assess the effectiveness of a quality improvement initiative aimed at reducing unnecessary CT scans for pediatric appendicitis.

Main Methods:

• A quality improvement team comprising stakeholders from three institutions developed and implemented interventions using the Model for Improvement.
• Key interventions included a clinical pathway for pediatric appendicitis, standardized ultrasound (US) report templates, and case audit with feedback.
• Process measures included US utilization and nondiagnostic US rates; balancing measures were transfer and "over-transfer" rates.

Main Results:

• The baseline CT scan rate was 32%, which was successfully decreased to 4.5% post-intervention, exceeding the 50% reduction aim.
• Ultrasound utilization was 63% with a 77% nondiagnostic rate at baseline; these were monitored as process measures.
• Frontline providers reported enhanced knowledge and practice standardization, with no increase in transfer or "over-transfer" rates.

Conclusions:

• A collaborative, pediatric-focused quality improvement initiative significantly reduced CT scan use in children with suspected appendicitis in community GED settings.
• The model emphasizing a community of practice, facilitated by the Emergency Medical Service for Children (EMSC), offers a scalable approach for future quality improvement efforts.