A Quality Improvement Initiative to Reduce Abdominal X-ray use in Pediatric Patients Presenting with Constipation

Area of Science:

• Pediatric Gastroenterology
• Quality Improvement Initiatives
• Diagnostic Imaging

Background:

• Constipation is a common pediatric complaint presenting to gastroenterology clinics.
• Abdominal radiographs are frequently used for constipation evaluation, but their necessity is debated.
• Standardizing initial assessment protocols can optimize diagnostic strategies.

Purpose of the Study:

• To decrease the percentage of pediatric patients undergoing abdominal radiographs within 24 hours of their initial gastroenterology visit for constipation.
• To evaluate the clinical impact of implementing an evidence-based guideline (EBG) on radiograph utilization.

Main Methods:

• An evidence-based guideline (EBG) was implemented in January 2015 to standardize constipation assessment.
• The study followed 6723 pediatric patients (6 months to 19 years) with constipation from 2013-2019.
• The primary outcome measured was the change in abdominal radiograph use within 24 hours of the initial visit.

Main Results:

• Abdominal radiograph use decreased from 24% to less than 11% within one year of EBG implementation.
• This reduction represented a greater than 50% decrease in routine radiograph use for constipation.
• A 57% decrease in hospital charges and no increase in subsequent emergency visits or hospitalizations were observed.

Conclusions:

• Local adoption of an EBG effectively reduced routine abdominal radiograph use in pediatric constipation evaluations.
• The observed reduction in imaging was sustained over a 5-year period.
• The quality improvement strategy demonstrated significant cost savings without compromising patient safety or increasing adverse outcomes.