title: Improving Quality and Efficiency for Intussusception Management After Successful Enema Reduction.
abstract: OBJECTIVE
  The purpose of this project was to implement a protocol facilitating discharge from the emergency department (ED) after successful radiologic ileocolic intussusception reduction in a pediatric referral center.
  
  
  METHODS
  A multidisciplinary team identified drivers for successful quality improvement including educational brochures, a standardized radiologic report, an observation period in the ER with oral hydration challenges, and follow-up phone calls the day after discharge. Patient outcomes were tracked, and quarterly feedback was provided.
  
  
  RESULTS
  Of 80 patients identified over a 24-month period, 34 (42.5%) did not qualify for discharge home due to need for surgical intervention (n = 9), specific radiologic findings (n = 11), need for additional intravenous hydration (n = 4), or other reasons (n = 7). Of 46 patients who qualified for discharge, 30 (65.2%) were successfully sent home from the ED. One patient returned with recurrent symptoms that required repeat enema reduction. Sixteen patients were observed and discharged within 23 hours. Adherence with discharge from the ED improved over time. Discharge from the ED was associated with cost savings and improved net margins at the hospital level for each encounter.
  
  
  CONCLUSIONS
  A sustainable multidisciplinary quality improvement project to discharge intussusception patients from the ED after air-contrast enema reduction was successfully integrated in a high-volume referral center through education, standardized radiologic reporting, and protocoled follow-up.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia; mehulvraval@emory.edu.
authors.forename: Mehul V
authors.initials: MV
authors.lastname: Raval
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, and.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, and.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
authors.affiliation: Quality Improvement Services, Nationwide Children's Hospital, Columbus, Ohio;
authors.forename: Kelli J
authors.initials: KJ
authors.lastname: Kurtovic
authors.affiliation: Ohio University College of Medicine, Athens, Ohio; and.
authors.forename: Ann
authors.initials: A
authors.lastname: Dietrich
authors.affiliation: Department of Radiology, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio;
authors.forename: D Gregory
authors.initials: DG
authors.lastname: Bates
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Shawn J
authors.initials: SJ
authors.lastname: Rangel
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, and.
authors.forename: R Lawrence
authors.initials: RL
authors.lastname: Moss
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, and.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Kenney
mesh_terms: D002648:Child; D002985:Clinical Protocols; D004636:Emergency Service, Hospital; D004733:Enema; D006801:Humans; D007077:Ileal Diseases / Q000628:therapy*; D007443:Intussusception / Q000628:therapy*; D010351:Patient Discharge; D058996:Quality Improvement; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome