Walser Emily, Davidson Jacob, Wigen Robin, Wilson Claire A, Seemann Natashia M, Lam Jennifer Y
From the Division of Paediatric Surgery, Children's Hospital, London Health Sciences Centre, London, Ont. (Walser, Davidson, Wilson, Seemann, Lam); the Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Ont. (Wigen, Seemann, Lam).
Can J Surg. 2025 Apr 17;68(2):E137-E145. doi: 10.1503/cjs.009024. Print 2025 Mar-Apr.
High rates of hospital revisits after pediatric appendectomy are costly to the health care system, patients, and families. We sought to trial a bundle of interventions targeted at reducing the rate of unnecessary revisits to hospital in this population.
In February 2021, a working group of relevant stakeholders was created. In June 2021, the group developed and implemented interventions to reduce revisits in a staggered fashion. Interventions included increased education provided to patients and their families, as well as nursing staff, revised discharge pamphlets, and a post-discharge phone call from our nurse practitioner. We tracked revisit rates prospectively using run charts with comparison to historical controls.
We tracked revisit rates from July 2018 to October 2022. A total of 793 appendectomies were performed. There was a downward trend in revisit rates, from 16.7% before interventions to 13.4% after intervention implementation, for a relative reduction of 20%. In the postintervention period, 193 appendectomies were performed, with 78.0% contacted by our nurse practitioner in the early postoperative period. Of those contacted, 74% received the discharge pamphlet and 98.7% of respondents expressed that the phone call was useful. Almost all respondents stated they would want the follow-up phone call if they were to have another child with appendicitis.
Simple, low-cost interventions aimed at improving education at time of discharge after pediatric appendectomy were associated with a reduction in unnecessary hospital revisits. Ongoing efforts are required to sustain results and assess efficacy of bundle elements to determine if additional initiatives may be beneficial in further reductions of revisits.
小儿阑尾切除术后较高的医院复诊率对医疗保健系统、患者及其家庭造成高昂成本。我们试图试验一系列干预措施，以降低该人群不必要的复诊率。
2021年2月，成立了一个由相关利益相关者组成的工作组。2021年6月，该小组制定并逐步实施了减少复诊的干预措施。干预措施包括加强对患者及其家属以及护理人员的教育、修订出院宣传册，以及由我们的执业护士进行出院后电话随访。我们使用运行图前瞻性地跟踪复诊率，并与历史对照进行比较。
我们跟踪了2018年7月至2022年10月的复诊率。共进行了793例阑尾切除术。复诊率呈下降趋势，从干预前的16.7%降至干预实施后的13.4%，相对降低了20%。在干预后阶段，进行了193例阑尾切除术，其中78.0%的患者在术后早期接受了我们执业护士的随访。在接受随访的患者中，74%收到了出院宣传册，98.7%的受访者表示电话随访很有用。几乎所有受访者表示，如果他们的另一个孩子患阑尾炎，他们希望能接到随访电话。
旨在改善小儿阑尾切除术后出院时教育的简单、低成本干预措施与减少不必要的医院复诊相关。需要持续努力以维持成果，并评估一系列干预措施的效果，以确定是否有其他举措可能有助于进一步降低复诊率。
