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Quality improvement report
Quality improvement methodology can reduce hospitalisation for abscess management
  1. Michael Dunn1,2,
  2. Kate Savoie3,4,
  3. Guliz Erdem5,6,
  4. Michael W Dykes7,
  5. Don Buckingham7,
  6. Sandra Spencer1,2,
  7. Gail Besner3,4,
  8. Brian Kenney3,4
  1. 1 Pediatric Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
  2. 2 Pediatric Emergency Medicine, The Ohio State University, Columbus, Ohio, USA
  3. 3 Pediatric Surgery, Nationwide Children's Hospital, Columbus, Ohio, USA
  4. 4 Pediatric Surgery, The Ohio State University, Columbus, Ohio, USA
  5. 5 Pediatric Infectious Disease, Nationwide Children's Hospital, Columbus, Ohio, USA
  6. 6 Pediatric Infectious Disease, The Ohio State University, Columbus, Ohio, USA
  7. 7 Department of Quality Improvement Services, Nationwide Children's Hospital, Columbus, Ohio, USA
  1. Correspondence to Dr Michael Dunn; michael.dunn{at}nationwidechildrens.org

Abstract

Background Abscesses are a common reason for ED visits. While many are drained in the ED, some require drainage in the operating room (OR). We observed that a higher percentage of patients at our institution in Columbus, Ohio, were admitted to the hospital with abscesses for incision and drainage (I&D) in the OR than other institutions, including paediatric institutions. Our aim was to decrease hospitalisations for abscess management.

Methods A multidisciplinary team convened to decrease hospitalisation for patients with abscesses and completed multiple ‘Plan-Do-Study-Act’ cycles, including increasing I&Ds performed in the ED. Other interventions included implementation of a clinical pathway, training of procedure technicians (PT), updating the electronic medical record (EMR), credentialing advanced practice nurses in sedation and individual follow-up with providers for admitted patients. Data were analysed using statistical process control charts. Gross average charges were assessed.

Results Admissions for I&D decreased from 26.3% to 13.7%. Abscess drainage in the ED improved from 79.3% to 96.5%. Mean length of stay decreased from 19.5 to 11.5 hours for all patients. Patients sedated increased from 3.3% to 18.2%. The number of repeat I&Ds within 30 days decreased from 4.3% to 1.7%.

Conclusion We decreased hospitalisations for abscess I&D by using quality improvement methodology. The most influential intervention was an initiative to increase I&Ds performed in the ED. Additional interventions included expanded training of PTs, implementation of a clinical pathway, updating the EMR, improving interdepartmental communication and increasing sedation providers.

  • quality improvement

https://doi.org/10.1136/emermed-2021-211466

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    Footnotes

    • Handling editor Edward Carlton

    • Twitter @kiddocdun

    • Contributors MD conceptualised and designed the study, drafted the initial manuscript, collected the data, carried out the initial analyses and reviewed and revised the manuscript. KS collected the data, carried out the data analyses and reviewed and revised the manuscript. GE and BK conceptualised and designed the study, carried out the initial analyses and reviewed and revised the manuscript. SS conceptualised and designed the study and reviewed and revised the manuscript. MWD and DB designed the data collection instruments, coordinated and supervised the data collection, carried out the initial analyses and critically reviewed the manuscript. GB conceptualised and designed the study and critically reviewed the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.