Standardization and improvement of care for pediatric patients with perforated appendicitis

摘要

Background/purpose Reduction of treatment variation and application of evidenced based care are increasingly important in the current care environment. Utilizing formal quality improvement methods, an evidenced based guideline was implemented at our institution. Methods A guideline was established regarding timing of surgery (immediate vs interval appendectomy) and duration of antibiotics. Twelve months of baseline data were collected prior to implementation. The guideline dictates immediate appendectomy (IA) and postoperative antibiotic therapy until discharge (regular diet, clinically improved, normal complete blood count (CBC)). Data was collected prospectively during hospitalization and at 30 days postdischarge. Control charts document adherence to the overall guideline, IA, antibiotic guideline, and readmission for complications. Results Guideline implementation resulted in an increase in IA (79% vs 94%), decrease in the use of IV antibiotics post discharge (25% to 4%), no change in overall LOS, no change in postoperative abscess formation, and slight decrease in 30 day readmission. Charges were decreased. Conclusion Implementation of an evidenced based guideline resulted in significant practice change for managing perforated appendicitis. The changes suggest more efficient care without compromising patient outcome. Utilization of quality improvement methods allows for implementing and tracking the change as well as creating a platform for future improvement.