title: Implementation of a small bowel obstruction guideline improves hospital efficiency.
abstract: BACKGROUND
  We performed an internal review of triage decisions and outcomes for all patients admitted for small bowel obstruction (SBO). Concern for potential delays in operation led to formalization of an institution-wide SBO management guideline. We hypothesized that use of the guideline would improve initial triage and patient outcomes.
  
  
  METHODS
  Members of the departments of surgery, medicine, and emergency medicine created a SBO service triage and initial management guideline that was instituted in 2011 after education and a multidisciplinary Grand Rounds on the subject. Administrative data from fiscal year 2010 (FY2010) was compared with the first 6 months of 2011. Time to computed tomography scan, the OR, general surgery (GS) consultation, and hospital duration of stay were collected and compared for those admitted to a medicine service before (Med2010) and after (Med2011) the guideline and those admitted to a general surgery service before (GS2010) and after (GS2011) the guideline. Groups were compared with Student t test and χ2 analysis.
  
  
  RESULTS
  There were 490 SBO admissions in FY2010 and 240 in the first 6 months of 2011. After implementation of the guidelines, the percent of SBO patients admitted to GS2011 increased from 55 to 66% (P < .01). The percent of patients admitted to a medicine service requiring operation for SBO did not change from 14 to 7% for Med2011, but there was a shorter time to GS consultation (P < .001). Time from admission to operation decreased from 0.9 to 0.4 days (P < .05) with a mean decrease in hospital duration of stay of 2 days (8 ± 6 compared with 6 ± 4 days, P < .001) for those admitted during GS2011.
  
  
  CONCLUSIONS
  Implementation of a hospital-wide SBO guideline that addressed initial management and triage shortened time to operative intervention and hospital duration of stay for patients requiring operative therapy for SBO.
authors.affiliation: Trauma and Surgical Critical Care, Saint Joseph Mercy Ann Arbor, Ann Arbor, MI 48106-0995, USA. wahlwl@trinity-health.org
authors.forename: Wendy L
authors.initials: WL
authors.lastname: Wahl
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wong
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Sonnenday
authors.forename: Mark R
authors.initials: MR
authors.lastname: Hemmila
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dimick
authors.forename: Scott A
authors.initials: SA
authors.lastname: Flanders
authors.forename: Jeff S
authors.initials: JS
authors.lastname: Desmond
authors.forename: Vinita
authors.initials: V
authors.lastname: Bahl
authors.forename: Peter K
authors.initials: PK
authors.lastname: Henke
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006760:Hospitalization; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy; D007421:Intestine, Small; D007902:Length of Stay; D008297:Male; D008824:Michigan; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014218:Triage