title: Standardization and improvement of care for pediatric patients with perforated appendicitis.
abstract: OBJECTIVE
  Reduction of treatment variation and application of evidenced based care are increasingly important in the current care environment. Utilizing formal quality improvement methods, an evidenced based guideline was implemented at our institution.
  
  
  METHODS
  A guideline was established regarding timing of surgery (immediate vs interval appendectomy) and duration of antibiotics. Twelve months of baseline data were collected prior to implementation. The guideline dictates immediate appendectomy (IA) and postoperative antibiotic therapy until discharge (regular diet, clinically improved, normal complete blood count (CBC)). Data was collected prospectively during hospitalization and at 30days postdischarge. Control charts document adherence to the overall guideline, IA, antibiotic guideline, and readmission for complications.
  
  
  RESULTS
  Guideline implementation resulted in an increase in IA (79% vs 94%), decrease in the use of IV antibiotics post discharge (25% to 4%), no change in overall LOS, no change in postoperative abscess formation, and slight decrease in 30day readmission. Charges were decreased.
  
  
  CONCLUSIONS
  Implementation of an evidenced based guideline resulted in significant practice change for managing perforated appendicitis. The changes suggest more efficient care without compromising patient outcome. Utilization of quality improvement methods allows for implementing and tracking the change as well as creating a platform for future improvement.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Joyce
authors.initials: J
authors.lastname: Slusher
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Christina A
authors.initials: CA
authors.lastname: Bates
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Johnson
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Williams
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Roshni
authors.initials: R
authors.lastname: Dasgupta
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. Electronic address: daniel.vonallmen@cchmc.org.
authors.forename: Daniel
authors.initials: D
authors.lastname: von Allmen
mesh_terms: D000293:Adolescent; D001062:Appendectomy / Q000592:standards*; D001064:Appendicitis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D017410:Practice Guidelines as Topic / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000379:methods*; D058996:Quality Improvement; D012189:Retrospective Studies; D055815:Young Adult
keywords: Evidence based practice; Interval appendectomy; Perforated appendicitis