Quality improvement methodology can reduce hospitalisation for abscess management

Area of Science:

• Quality Improvement in Healthcare
• Surgical Procedures
• Emergency Medicine

Background:

• Abscesses frequently lead to emergency department (ED) visits, with some requiring surgical intervention in the operating room (OR).
• A notable percentage of patients at the institution in Columbus, Ohio, were admitted for OR incision and drainage (I&D) compared to other facilities.
• The primary objective was to reduce hospital admissions for abscess management.

Purpose of the Study:

• To decrease hospitalizations for patients requiring abscess incision and drainage (I&D).
• To improve the efficiency and effectiveness of abscess management within the healthcare system.

Main Methods:

• A multidisciplinary team utilized 'Plan-Do-Study-Act' cycles to implement changes.
• Key interventions included increasing ED-based I&Ds, establishing a clinical pathway, and enhancing procedure technician (PT) training.
• Electronic medical record (EMR) updates, advanced practice nurse credentialing for sedation, and provider follow-up were also implemented.

Main Results:

• Hospital admissions for I&D decreased from 26.3% to 13.7%.
• Emergency department abscess drainage rates improved from 79.3% to 96.5%.
• Mean length of stay reduced from 19.5 to 11.5 hours, and repeat I&Ds within 30 days dropped from 4.3% to 1.7%.

Conclusions:

• Quality improvement methodology successfully reduced hospitalizations for abscess I&D.
• Increasing ED-based I&Ds was the most impactful intervention.
• Additional successful interventions included enhanced PT training, clinical pathway implementation, EMR updates, and improved sedation services.