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J Surg Res. 2019 Dec;244:122-129. doi: 10.1016/j.jss.2019.06.036. Epub 2019 Jul 5.

Intussusception Protocol Implementation: Single-Site Outcomes With Clinician and Family Satisfaction.

Author information

1
Department of Surgery, University of Michigan, Michigan Medicine, Section of Pediatric Surgery, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
2
Department of Emergency Medicine, University of Michigan, Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
3
Department of Emergency Medicine, University of Michigan, Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, Michigan; Department of Pediatric Emergency Medicine, Virginia Commonwealth University, Richmond, Virginia.
4
Department of Emergency Medicine, University of Michigan, Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, Michigan; Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, Illinois.
5
Department of Emergency Medicine, University of Michigan, Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, Michigan; Department of Pediatrics, University of Michigan, Michigan Medicine, C.S. Mott Children's Hospital, Ann Arbor, Michigan.
6
Department of Surgery, University of Michigan, Michigan Medicine, Section of Pediatric Surgery, C.S. Mott Children's Hospital, Ann Arbor, Michigan. Electronic address: eperrone@med.umich.edu.

Abstract

BACKGROUND:

The objective of this study was to evaluate clinical outcomes, costs, and clinician and parent satisfaction after implementation of a protocol to discharge patients from the emergency department (ED) after successful reduction of uncomplicated ileocolic intussusception.

MATERIALS AND METHODS:

In March 2017, an intussusception management protocol was implemented for children presenting with ultrasound findings of ileocolic intussusception. Those meeting inclusion criteria were observed after successful radiological reduction in the ED and discharged after 6 h with resolution of symptoms. Retrospective chart review was completed for cases before and after protocol implementation for clinical outcomes and costs. Clinicians and parents were surveyed to assess overall satisfaction.

RESULTS:

Charts were reviewed before (42 encounters, 37 patients) and after (30 encounters, 23 patients) protocol implementation. After implementation, admission rates decreased from 95% (40/42) to 23% (7/30; P < 0.001) and antibiotic use was eliminated (91% to 0%, P < 0.001). There was no difference in recurrence rates (17% versus 23%, P = 0.44). Median total length of stay decreased from 18.87 to 9.52 h (P < 0.001), whereas median ED length of stay increased from 4.37 to 9.87 h (P < 0.001). In addition, there was an overall hospital cost saving of over $2000 ($9595 ± 3424 to $7465 ± 3723; P = 0.009) per encounter. Clinicians and parents were overall satisfied with the protocol and parents showed no changes in patient satisfaction with protocol implementation.

CONCLUSIONS:

An intussusception protocol can facilitate early discharge from the ED and improve patient care without increased risk of recurrence. Additional benefits include decreased hospital- and patient-related costs, elimination of antibiotic use, and parent as well as clinician satisfaction.

KEYWORDS:

Clinician satisfaction; Cost analysis; Intussusception; Parent satisfaction; Protocol implementation

PMID:
31284141
DOI:
10.1016/j.jss.2019.06.036

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