A quality improvement project targeting postoperative hospital revisit rates after pediatric appendicitis.

Abstract

Background: High rates of hospital revisits after pediatric appendectomy are costly to the health care system, patients, and families. We sought to trial a bundle of interventions targeted at reducing the rate of unnecessary revisits to hospital in this population.

Methods: In February 2021, a working group of relevant stakeholders was created. In June 2021, the group developed and implemented interventions to reduce revisits in a staggered fashion. Interventions included increased education provided to patients and their families, as well as nursing staff, revised discharge pamphlets, and a post-discharge phone call from our nurse practitioner. We tracked revisit rates prospectively using run charts with comparison to historical controls.

Results: We tracked revisit rates from July 2018 to October 2022. A total of 793 appendectomies were performed. There was a downward trend in revisit rates, from 16.7% before interventions to 13.4% after intervention implementation, for a relative reduction of 20%. In the postintervention period, 193 appendectomies were performed, with 78.0% contacted by our nurse practitioner in the early postoperative period. Of those contacted, 74% received the discharge pamphlet and 98.7% of respondents expressed that the phone call was useful. Almost all respondents stated they would want the follow-up phone call if they were to have another child with appendicitis.

Conclusion: Simple, low-cost interventions aimed at improving education at time of discharge after pediatric appendectomy were associated with a reduction in unnecessary hospital revisits. Ongoing efforts are required to sustain results and assess efficacy of bundle elements to determine if additional initiatives may be beneficial in further reductions of revisits.