Development and Implementation of a Surgical Quality Improvement Pathway for Pediatric Intussusception Patients
*Alexander V Chalphin, *Stephanie K Serres, *Rosella Micalizzi, *Michele Dawson, *Caitlin Phinney, *Angelique Hrycko, *Ariel Martin-Quashie, *Michael Pepin, Charles J. Smithers, Shawn Rangel, Catherine Chen
Boston Children's Hospital, BOSTON, MA
Objective: Implement a standardized clinical assessment and management plan (SCAMP) for ileocolic intussusception allowing safe discharge from the emergency department (ED) in select cases and determine optimal management of patients returning to care, including those with recurrent intussusception.
Design: Prospective cohort study.
Setting: Boston Children’s Hospital (Boston, MA), a quaternary care standalone children’s hospital.
Patients: From February 2013 through December 2017, 118 encounters with patients age 6 months to 6 years with ultrasound confirmed ileocolic intussusception were managed through the SCAMP.
Interventions: Eligible patients did not receive antibiotics and were discharged if stable following successful reduction with 2 planned follow-up phone calls by surgical personnel at 24-hours and either 7 (pilot 1) or 3 (pilot 2) days after discharge.
Main Outcome Measures: Complications, incidence of bacteremia, success of follow-up phone calls, recurrent intussusception, and rates of return to care.
Results: Overall, 76% of patients met discharge criteria, 88% of whom were discharged. There were no instances of bowel perforation, necrosis, or death in the discharged group. Antibiotics were not given for the indication of intussusception, and no patients developed bacteremia. Successful 24-hour follow-up calls were made to 62% and 59% of patients and successful second follow-up calls were made to 28% and 55% of patients in pilots 1 and 2, respectively. Of those discharged, 74% never returned to care, 19% returned for recurrent intussusception, and 7% returned for unrelated symptoms. Nearly all patients who returned to care in pilots 1 and 2 did so through the ED and not the clinic.
Conclusions: Patients meeting certain criteria can be safely discharged from the ED, avoid antibiotics, and be followed by phone for concerns of recurrent intussusception.
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