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Early discharge after nonoperative management of intussusception is both safe and cost-effective
Seyed A Arshad1, Nutan B Hebballi2, Brittany N Hegde1
1Center for Surgical Trials and Evidence-Based Practice (C-STEP), McGovern Medical School, University of Texas Health Science Center, 6431 Fannin Street, MSB 5.256, Houston, TX 77030, United States; Department of Pediatric Surgery, McGovern Medical School, University of Texas Health Science Center, 6431 Fannin Street, MSB 5.246, Houston, TX 77030, United States; Children's Memorial Hermann Hospital, 6411 Fannin Street, Houston, TX 77030, United States.
Insights
A quality improvement initiative safely reduced monitoring for pediatric intussusception patients, decreasing hospital stays and costs. Recurrence rates remained unchanged, showing the initiative
Area of Science:
- Pediatric Gastroenterology
- Quality Improvement Science
- Health Economics
Background:
- Ileocolic intussusception is a common pediatric surgical emergency.
- Current management protocols often involve prolonged post-reduction monitoring.
- Reducing monitoring may optimize resource utilization without compromising patient safety.
Purpose of the Study:
- To implement and evaluate a quality improvement (QI) initiative to reduce post-reduction monitoring for pediatric ileocolic intussusception.
- To assess the impact of the QI initiative on length of stay (LOS) and hospital costs.
- To determine if the QI initiative affected intussusception recurrence rates.
Main Methods:
- Retrospective cohort study of pediatric patients with ileocolic intussusception undergoing enema reduction.
- Comparison of outcomes before (pre-QI) and after (post-QI) implementation of a new management protocol allowing earlier discharge.
- Economic evaluation of hospital costs, adjusted for inflation and analyzed using multivariable regression.
Main Results:
- The post-QI group had a significantly shorter median LOS (9.3 hours vs. 23.4 hours, P < 0.001).
- Mean total costs per patient were reduced by $1,370 in the post-QI group.
- There were no significant differences in post-discharge encounters or intussusception recurrence rates between groups.
Conclusions:
- Implementation of a QI initiative successfully reduced LOS and hospital costs for pediatric intussusception.
- The QI initiative did not negatively impact patient outcomes, including recurrence rates.
- This protocol can be readily adopted by other institutions to improve care efficiency.
Background/Purpose:
We implemented a quality improvement (QI) initiative to safely reduce post-reduction monitoring for pediatric patients with ileocolic intussusception. We hypothesized that there would be decreased length of stay (LOS) and hospital costs, with no change in intussusception recurrence rates.
Methods:
A retrospective cohort study was conducted of pediatric ileocolic intussusception patients who underwent successful enema reduction at a tertiary-care pediatric hospital from January 2015 through June 2020. In September 2017, an intussusception management protocol was implemented, which allowed discharge within four hours of reduction. Pre- and post-QI outcomes were compared for index encounters and any additional encounter beginning within 24 h of discharge. An economic evaluation was performed with hospital costs inflation-adjusted to 2020 United States Dollars ($). Cost differences between groups were assessed using multivariable regression, adjusting for Medicaid and transfer status, P < 0.05 significant.
Results:
Of 90 patients, 37(41%) were pre-QI and 53(59%) were post-QI. Patients were similar by age, sex, race, insurance status, and transfer status. Pre-QI patients had a median LOS of 23.4 h (IQR: 16.1-34.6) versus 9.3 h (IQR 7.4-14.2) for post-QI patients, P < 0.001. Mean total costs per patient in the pre-QI group were $3,231 (95% CI, $2,442-$4,020) versus $1,861 (95% CI, $1,481-$2,240) in the post-QI group. The mean absolute cost difference was $1,370 less per patient in the post-QI group (95% CI, [-$2,251]-[-$490]). Five patients had an additional encounter within 24 h of discharge [pre-QI: 1 (3%) versus post-QI: 4 (8%), p = 0.7] with four having intussusception recurrence [pre-QI: 1 (3%) versus post-QI: 3 (6%), p = 0.6].
Conclusions:
Implementation of a quality improvement initiative for the treatment of pediatric intussusception reduced hospital length of stay and costs without negatively affecting post-discharge encounters or recurrence rates. Similar protocols can easily be adopted at other institutions.
Level Of Evidence:
Level III.
Type Of Study:
Retrospective comparative treatment study.
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