AlFraih Yasser, Robinson Tessa, Stein Nina, Kam April, Flageole Helene
Division of Pediatric General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
McMaster Children's Hospital, Hamilton, Ontario, Canada.
Pediatr Qual Saf. 2020 May 13;5(3):e290. doi: 10.1097/pq9.0000000000000290. eCollection 2020 May-Jun.
Considerable variability exists in the diagnosis and management of acute appendicitis, affecting both quality and costs of care. This prospective cohort study aimed to decrease unnecessary radiological investigations, standardize radiological imaging, avoid unnecessary hospital admissions, and decrease our institution rate of negative appendectomy.
A multidisciplinary appendicitis care pathway was implemented. This pathway involved the use of the Pediatric Appendicitis Score, standardization of ultrasound reporting, and risk stratification to determine patient disposition. Patients were prospectively enrolled in the pathway and compared a preimplementation retrospective cohort.
We included 235 patients in this study that took place between February 2017 and January 2018. An 88.5% pathway adherence rate for appropriate referral for ultrasounds, an 84% compliance rate for correct risk stratification, and the need for a surgical consult were achieved. After implementation, standardization of ultrasound (U/S) reporting increased from 0% to 78%. The rate of computed tomography utilization decreased from 7.3% to 4.7%. An appendectomy was completed in 68 (29%) of patients. There was only 1 (1.5%) negative appendectomy, compared to the prepathway institutional negative appendectomy rate of 4%.
The implementation of a standardized, evidence-based, appendicitis care pathway has the potential to improve quality of care by reducing negative appendectomies, unnecessary computed tomography scans, and unnecessary hospital admissions. The participation of the emergency and diagnostic imaging departments is critical to the successful implementation of this quality improvement measure. This simple, effective model can be easily implemented at other centers to improve the care of children.
急性阑尾炎的诊断和管理存在很大差异，这影响了医疗质量和成本。这项前瞻性队列研究旨在减少不必要的放射学检查，规范放射学成像，避免不必要的住院，并降低我们机构的阴性阑尾切除术发生率。
实施了多学科阑尾炎护理路径。该路径包括使用小儿阑尾炎评分、超声报告标准化以及风险分层以确定患者处置方式。患者被前瞻性纳入该路径，并与实施前的回顾性队列进行比较。
我们纳入了2017年2月至2018年1月期间的235例患者。超声适当转诊的路径依从率为88.5%，正确风险分层的依从率为84%，并实现了手术会诊的需求。实施后，超声（U/S）报告的标准化从0%提高到了78%。计算机断层扫描的利用率从7.3%降至4.7%。68例（29%）患者完成了阑尾切除术。只有1例（1.5%）阴性阑尾切除术，而路径实施前机构的阴性阑尾切除术发生率为4%。
实施标准化、循证的阑尾炎护理路径有可能通过减少阴性阑尾切除术、不必要的计算机断层扫描和不必要的住院来提高医疗质量。急诊科和诊断影像科的参与对于成功实施这项质量改进措施至关重要。这个简单有效的模型可以很容易地在其他中心实施，以改善儿童护理。
