Fellow Emory University School of Medicine Decatur, Georgia, United States
Background: Functional constipation is very common in children and abdominal radiographs are not indicated for routine evaluation. Oral treatment regimens are recommended for most children with functional constipation.
Problem At our Children’s hospital’s three Emergency Departments (ED), in 6749 constipation-related visits between June 2022 through May 2023, 51% had abdominal radiographs and 25% had enemas during the ED visit. Objective: 1: Reduce abdominal radiograph from 51% to 40% for constipation patients (ESI 3-5 without vomiting) within 12 months. 2: Decrease enema use from 25% to 20% for constipation patients (ESI 2-5, pain score < 5) within 12 months. Design/Methods: Setting and Context: Large academic pediatric hospital with three EDs. Patients are triaged using ESI (Emergency Severity Index) scores from 1 (highest acuity) to 5 (lowest acuity). We included children aged 6 months to 21 years seen and discharge for complaint or diagnosis of constipation and excluded highest risk patients (ESI 1), chronic complex conditions, and prior abdominal surgery.
Intervention: Education, individualized feedback with metrics, and incentives (AAP MOC Part IV credit).
Measures: (1) Proportion of patients seen and discharged from the ED for complaint or diagnosis of constipation who had an abdominal radiograph. (2) Proportion of patients seen and discharged from the ED for complaint or diagnosis of constipation who received enema. Balancing measures include percentage of patients with return visits to the ED within 72 hours and 7 days, as well as admission during return visits. We also monitor the percentage of patients who received enemas, abdominal radiographs, and alternate diagnoses during their revisit.
Analysis: Group data will be analyzed monthly via control charts using standard rules for special cause. Providers will also receive individual data for the duration of the MOC project.
