A POCUS-first pathway to streamline care for children with suspected ileocolic intussusception
Hadas Katz-Dana1,2,3, Maya Harel-Sterling4, Danielle Vincent4,5
1Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada. hadaskat@gmail.com.
Insights
Implementing a point-of-care ultrasound (POCUS) first approach significantly reduced the time to intussusception reduction in children. This POCUS pathway streamlines care and improves efficiency in the Pediatric Emergency Department.
Area of Science:
- Pediatric Emergency Medicine
- Medical Imaging
- Quality Improvement
Background:
- Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable tool for screening intussusception in pediatric patients.
- Traditional workflows for suspected intussusception often involve delays in diagnosis and treatment.
- There is a need to optimize emergency department (ED) workflows for conditions requiring rapid intervention, such as intussusception.
Purpose of the Study:
- To implement and evaluate a "POCUS-first" pathway for children with suspected intussusception in a Pediatric Emergency Department.
- To assess the impact of the "POCUS-first" pathway on workflow efficiency, specifically time to diagnosis and intervention.
- To compare key performance metrics between a "POCUS-first" cohort and a traditional radiology-performed ultrasound cohort.
Main Methods:
- A prospective analysis was conducted on children diagnosed with ileocolic intussusception between June 2022 and June 2023.
- The study compared a "POCUS-first" pathway group (n=29) with a group receiving only radiology-performed ultrasound (non-POCUS group, n=70).
- Key outcome measures included physician initial assessment to radiology-performed ultrasound time and physician initial assessment to reduction time. Continuous improvement involved physician training and plan-do-study-act cycles.
Main Results:
- The "POCUS-first" pathway group showed a significantly shorter physician initial assessment to reduction time (170.7 min) compared to the non-POCUS group (240.6 min, p=0.02).
- For non-transferred patients, the "POCUS-first" group experienced a significantly shorter ED length of stay (386 min) versus the non-POCUS group (544 min, p=0.047).
- These findings indicate enhanced process efficiency with the implementation of the POCUS-first pathway.
Conclusions:
- Implementing a "POCUS-first" pathway for ileocolic intussusception management significantly improves process efficiency.
- The reduction in physician initial assessment to reduction time suggests expedited decision-making and intervention are achievable.
- The "POCUS-first" pathway demonstrates potential to optimize the management and outcomes for children with ileocolic intussusception.
Objectives:
As point-of-care ultrasound (POCUS) has emerged as a valuable tool for intussusception screening, this quality improvement study aimed to implement a "POCUS-first" pathway in a Pediatric Emergency Department (ED) to streamline workflow and expedite care for children with suspected intussusception.
Methods:
This was a prospective analysis of children diagnosed with ileocolic intussusception in a Pediatric ED between June 2022 and June 2023. The study compared the "POCUS-first" cohort with the group receiving only radiology-performed ultrasound. Key outcomes included physician initial assessment to radiology-performed US time and physician initial assessment to reduction time. Continuous improvement efforts incorporated pediatric emergency medicine physician training, education, and pathway dissemination through plan-do-study-act cycles.
Results:
The study included 29 patients in the "POCUS-first" pathway group and 70 patients in the non-POCUS group. The "POCUS-first" pathway demonstrated a significantly shorter physician initial assessment to reduction time compared to the non-POCUS group (170.7 min vs. 240.6 min, p = 0.02). Among non-transferred patients, the "POCUS-first" group also had a significantly shorter emergency department length of stay (386 min vs. 544 min, p = 0.047).
Conclusions:
Implementation of a "POCUS-first" pathway for managing ileocolic intussusception led to notable improvements in process efficiency. The shorter physician initial assessment to reduction time highlights the potential for expedited decision-making and intervention. These study findings support the potential of this pathway to optimize the management and outcomes of children with ileocolic intussusception.
Related Concept Videos
01:21Inflammatory Bowel Disease V: Surgical Management
Here are some common surgical interventions for IBD:
01:26Endoscopic Procedures IV: Sigmoidoscopy and Laproscopy
Sigmoidoscopy
Sigmoidoscopy is a diagnostic procedure that uses a flexible sigmoidoscope equipped with a light source and camera to examine the rectum and sigmoid colon. The procedure involves inserting the tube through the anus...
01:21Drugs for Treatment of Constipation-Predominant IBS
01:25Endoscopic Procedures II: Colonoscopy
01:29Appendicitis-II: Diagnostic Studies and Management
Diagnosing Appendicitis
It requires a multifaceted approach, starting with a detailed physical examination to pinpoint the location and nature of the pain and identify any associated symptoms. Laboratory tests play a crucial role. A complete Blood Count (CBC) typically reveals leukocytosis (an increased number of...
01:28Endoscopic Procedures III: Video Capsule Endoscopy