title: The impact of an acute care surgery clinical care pathway for suspected appendicitis on the use of CT in the emergency department.
abstract: BACKGROUND
  The natural evolution of an acute care surgery (ACS) service is to develop disease-specific care pathways aimed at quality improvement. Our primary goal was to evaluate the implementation of an ACS pathway dedicated to suspected appendicitis on patient flow and the use of computed tomography (CT) in the emergency department (ED).
  
  
  METHODS
  All adults within a large health care system (3 hospitals) with suspected appendicitis were analyzed during our study period, which included 3 time periods: pre- and postimplementation of the disease-specific pathway and at 12-month follow-up.
  
  
  RESULTS
  Of the 1168 consultations for appendicitis that took place during our study period, 349 occurred preimplementation, 392 occurred postimplementation, and 427 were follow-up visits. In all, 877 (75%) patients were admitted to the ACS service. Overall, 83% of patients underwent surgery within 6 hours. The mean wait time from CT request to obtaining the CT scan decreased with pathway implementation at all sites (197 v. 143 min, p < 0.001). This improvement was sustained at 12-month followup (131 min, p < 0.001). The pathway increased the number of CTs completed in under 2 hours from 3% to 42% (p < 0.001). No decrease in the total number of CTs or the pattern of ultrasonography was noted (p = 0.42). Wait times from ED triage to surgery were shortened (665 min preimplementation, 633 min postimplementation, 631 min at the 12-month follow-up, p = 0.040).
  
  
  CONCLUSIONS
  A clinical care pathway dedicated to suspected appendicitis can decrease times to both CT scan and surgical intervention.
authors.affiliation: The Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alta.
authors.forename: Chad G
authors.initials: CG
authors.lastname: Ball
authors.affiliation: The Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alta.
authors.forename: Elijah
authors.initials: E
authors.lastname: Dixon
authors.affiliation: The Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alta.
authors.forename: Anthony R
authors.initials: AR
authors.lastname: MacLean
authors.affiliation: The Department of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alta.
authors.forename: Gilaad G
authors.initials: GG
authors.lastname: Kaplan
authors.affiliation: The Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alta.
authors.forename: Lynn
authors.initials: L
authors.lastname: Nicholson
authors.affiliation: The Department of Surgery, University of Calgary, Foothills Medical Centre, Calgary, Alta.
authors.forename: Francis R
authors.initials: FR
authors.lastname: Sutherland
mesh_terms: D000208:Acute Disease; D000328:Adult; D000416:Alberta; D001062:Appendectomy; D001064:Appendicitis / Q000000981:diagnostic imaging* / Q000601:surgery; D019091:Critical Pathways; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D058996:Quality Improvement / Q000706:statistics & numerical data*; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000592:standards / Q000706:statistics & numerical data*; D014218:Triage