Hockenbury Jennifer, Lopez Monica E, Godfrey Caroline M, Blakely Martin L, Danko Melissa, Hernanz-Schulman Marta, Frazier S Barron
From the Division of Pediatric Emergency Medicine, University of Louisville, Louisville, Ky.
Department of Pediatric Surgery, Vanderbilt University Medical Center, Nashville, Tenn.
Pediatr Qual Saf. 2025 May 19;10(3):e808. doi: 10.1097/pq9.0000000000000808. eCollection 2025 May-Jun.
Appendicitis is the most common pediatric surgical emergency, and computed tomography (CT) remains an overused diagnostic test for appendicitis. Our institutional rate of CT utilization for suspected appendicitis was higher than in peer children's hospitals, so we aimed to reduce CT utilization during the evaluation of pediatric appendicitis from 31.3% to 15% within 12 months.
From September 2021 to October 2022, we conducted a multidisciplinary quality improvement initiative among patients evaluated for appendicitis in the pediatric emergency department (PED). Interventions included standardizing evaluation with a clinical practice guideline, an order set in the electronic medical record for clinical decision support, and radiologist use of an ultrasound report template. The primary measure was the percentage of patients undergoing evaluation for appendicitis who received an abdominal CT scan. Process measures were the timing of surgical consultation and ultrasound report template use. Balancing measures included negative pathology appendectomies and PED return visits within 72 hours with subsequent appendicitis diagnosis. We analyzed data using statistical process control charts and Nelson rules to detect special cause variation.
We evaluated a total of 2,010 patients for acute appendicitis, with 624 representing baseline encounters with a CT rate of 31.3%. Quality improvement interventions reduced the CT rate to 12.1% sustained for 10 months without impacting the rate of negative pathology appendectomy or PED return visits within 72 hours.
Quality improvement methodology led to a sustained reduction in CT utilization for patients undergoing evaluation for appendicitis in a PED.
阑尾炎是最常见的小儿外科急症，而计算机断层扫描（CT）仍是一种对阑尾炎过度使用的诊断测试。我们机构对疑似阑尾炎的CT使用率高于同行儿童医院，因此我们旨在在12个月内将小儿阑尾炎评估期间的CT使用率从31.3%降至15%。
从2021年9月至2022年10月，我们在儿科急诊科（PED）对接受阑尾炎评估的患者开展了一项多学科质量改进举措。干预措施包括使用临床实践指南规范评估、在电子病历中设置医嘱集以提供临床决策支持，以及放射科医生使用超声报告模板。主要指标是接受阑尾炎评估的患者中接受腹部CT扫描的百分比。过程指标是手术会诊时间和超声报告模板的使用情况。平衡指标包括阴性病理结果的阑尾切除术以及72小时内再次就诊并随后诊断为阑尾炎的PED复诊情况。我们使用统计过程控制图和纳尔逊规则分析数据以检测特殊原因变异。
我们共评估了2010例急性阑尾炎患者，其中624例为基线病例，CT使用率为31.3%。质量改进干预措施将CT使用率降至12.1%，并持续了10个月，且未影响阴性病理结果阑尾切除术的发生率或72小时内的PED复诊率。
质量改进方法使PED中接受阑尾炎评估的患者的CT使用率持续降低。
