Standardized management of pediatric abdominal pain admissions improves patient outcomes – A quality improvement project

Abstract

Background Children commonly present at the emergency department with abdominal pain and it is challenging to identify urgent surgical conditions. An audit conducted at a tertiary children’s hospital showed that 70% of patients admitted to Department of Pediatric Surgery (PAS) for abdominal pain had non-surgical diagnoses and wide variation in management. Objective Our quality improvement (QI) project aimed to reduce length of stay (LOS) and unnecessary investigations performed for patients admitted to PAS with abdominal pain, without causing complications or delayed diagnosis of surgical conditions. Methods The QI project consists of a standardised management workflow with stringent discharge criteria. We reviewed outcome measures of LOS, number of investigations ordered, compliance to workflow and readmission within 1-week post discharge at the end of each Plan-Do- Study-Act (PDSA) cycle and iteratively improved the workflow following QI principles. Results 61% of patients were admitted to PAS for non-surgical abdominal pain throughout three PDSA cycles conducted. The third cycle showed improved compliance to workflow (80.7%) with reduced median LOS by 1 day, reduced median number of blood, stool and urine investigations by 1 and reduced range of investigations ordered. Readmission and CE attendance rate 1 week after discharge was 1.6% ( n = 3), which was comparable to audit at 2.3% ( n = 4), p = 0.709. Conclusion The workflow reduced LOS, number of unnecessary investigations and variability in investigations ordered, without causing misdiagnosis. It improved patient experience with sizeable cost savings for the patient and the hospital. QI projects can improve patient outcomes by introducing standard protocols that aid clinical management.