Browne, Marybeth, MD

Geist, Heather

Iobst, Taylor

Thatch, Keith A, MD

Zimel, Catherine

English

Lehigh Valley Health Network: LVHN Scholarly Works

Lehigh Valley Health NetworkLVHN Scholarly WorksResearch Scholars Poster PresentationDo Better: Using NSQIP-Pediatrics to targetquality improvement initiatives for appendicitisTaylor IobstTaylor.Iobst@lvhn.orgCatherine ZimelHeather GeistLehigh Valley Health Network, heather.geist@lvhn.orgKeith A. Thatch MDLehigh Valley Health Network, Keith_A.Thatch@lvhn.orgMarybeth Browne MDLehigh Valley Health Network, Marybeth.Browne@lvhn.orgFollow this and additional works at: https://scholarlyworks.lvhn.org/research-scholars-postersThis Poster is brought to you for free and open access by LVHN Scholarly Works. It has been accepted for inclusion in LVHN Scholarly Works by anauthorized administrator. For more information, please contact LibraryServices@lvhn.org.Published In/Presented AtIobst, T., Zimel, C., Trexler, D., Geist, H., Thatch, K., Browne, M., (2016, July, 29) Do Better: Using NSQIP-Pediatrics to target qualityimprovement initiatives for appendicitis. Poster presented at LVHN Research Scholar Program Poster Session, Lehigh Valley HealthNetwork, Allentown, PA.© 2016 Lehigh Valley Health NetworkLehigh Valley Health Network, Allentown, PennsylvaniaDo Better: Using NSQIP-Pediatrics to target quality improvement initiatives for appendicitisAll (n=184) Acute (n=152) Perforated (n=32)ER to Diag 5:12(n=146) 4:42(n=118) 5:43(n=28)Diag to Surgery 9:42 (n=166) 9:26 (n=135) 11:30 (n=28)ER to Surgery 15:06 (n=178) 13:15 (n=146) 16:57 (n=32)Length of Stay 2.63 1.75 6.81• Retrospective analysis of pediatric patients undergoing appendectomy from January, 2015 to April, 2016 using the NSQIP-P database• Outcomes Reviewed– Demographics– Average Time from ER to Diagnosis– Average Time from Diagnosis to Surgery– Average Time from ER to Surgery– Length of Stay– Radiological utilization – Laboratory utilization– Post-operative complications– Readmissions• Exclusion Criteria– Incidental and Interval appendectomies– Incomplete documentation– Radiological and laboratory studies performed outside the networkTaylor Iobst, Debra Trexler RN, Catherine Zimel, Heather Geist, Keith Thatch MD, Marybeth Browne MDDepartment of Surgery, Division of Pediatric SurgeryINTRODUCTIONMETHODSRESULTSCONCLUSION/FUTURE STUDIES•The American College of Surgeons National Surgical Quality Improvement Program, Pediatrics(NSQIP-P) is a national database that provides high-quality, risk-stratified data that allows hospitals to compare surgical outcomes to other participating programs.•Appendectomy is the most commonly performed abdominal surgical procedure in the pediatric population.•The purpose of this project was to analyze our appendectomy outcomes and compare them to national standards when available.Table 1: Length of stayFigure 1: Radiological utilization *American College of Radiology recommend that a US be performed before a CT in the diagnosis of appendicitis 100% of the time. The national average for NSQIP hospitals is 62%. The  NSQIP national average for CT scan use is 25%.All (n=151)RepeatedCMP & BMP 116.5% 7.4%CBC 99.3% 27.3%PT/PTT/INR 5.3% .7%Sed.Rate & CRP 13.2% 0%Urinalysis 79.5% 4.2%Table 3a: Pre-op laboratory utilizationAll (n=151)RepeatedCMP & BMP 11.9% 27.8%CBC 20.5% 32.3%PT/PTT/INR 3.3% .7%Sed. Rate & CRP 1.3% 0%Urinalysis 3.3% 0%0102030405060708090100US CT US before CTLVH 17th St Muhlenberg98/10814/197/2535/1088/1915/2525/354/84/1592%74%28%33%71%50%42%60%27%Table 2: Post-operative complicationsAll (n=184) Acute (n=152) Perforated (n=32)Readmission Rate 5.4% 2.0% 21.9%Abscess Rate 5.4% 2.0% 21.9%•Many of our outcomes do not meet national benchmarks or norms.•There is an over utilization of laboratory studies.•The network does not meet national standards for the  use of radiological studies.• Based off these quality outcomes, we will be developing an appendectomy task force with members from ER, radiology, OR, and surgery.•Our goal is to decrease length of stay, CT scan use, laboratory utilization, and post-operative complications in order to achieve Better Health, Better Care, Better Cost. REFERENCESSlusher et al.  Standardization and Improvement  of care for pediatric patients with perforated appendicitis. Journal of  Pediatric Surgery, 49, 1020 1025. (2014).Rice-Townsend et al. Variation in risk-adjusted hospital readmission after treatment of appendicitis at 38 children’s hospitals: an opportunity for collaborative quality improvement. Annals of Surgery, 257(4),758-765.(2013).Bachur et al. Effect of reduction in the use of computed tomography on clinical outcomes of appendicitis. JAMA Pediatrics, 16(8), 755-760. (2015)Table 3b: Post-op laboratory utilization

Do Better: Using NSQIP-Pediatrics to target quality improvement initiatives for appendicitis

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Do Better: Using NSQIP-Pediatrics to target quality improvement initiatives for appendicitis

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