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A POCUS-first pathway to streamline care for children with suspected ileocolic intussusception

  • Quality Improvement and Patient Safety (QIPS)
  • Published:
Canadian Journal of Emergency Medicine Aims and scope Submit manuscript

Abstract

Objectives

As point-of-care ultrasound (POCUS) has emerged as a valuable tool for intussusception screening, this quality improvement study aimed to implement a “POCUS-first” pathway in a Pediatric Emergency Department (ED) to streamline workflow and expedite care for children with suspected intussusception.

Methods

This was a prospective analysis of children diagnosed with ileocolic intussusception in a Pediatric ED between June 2022 and June 2023. The study compared the “POCUS-first” cohort with the group receiving only radiology-performed ultrasound. Key outcomes included physician initial assessment to radiology-performed US time and physician initial assessment to reduction time. Continuous improvement efforts incorporated pediatric emergency medicine physician training, education, and pathway dissemination through plan-do-study-act cycles.

Results

The study included 29 patients in the “POCUS-first” pathway group and 70 patients in the non-POCUS group. The “POCUS-first” pathway demonstrated a significantly shorter physician initial assessment to reduction time compared to the non-POCUS group (170.7 min vs. 240.6 min, p = 0.02). Among non-transferred patients, the “POCUS-first” group also had a significantly shorter emergency department length of stay (386 min vs. 544 min, p = 0.047).

Conclusions

Implementation of a “POCUS-first” pathway for managing ileocolic intussusception led to notable improvements in process efficiency. The shorter physician initial assessment to reduction time highlights the potential for expedited decision-making and intervention. These study findings support the potential of this pathway to optimize the management and outcomes of children with ileocolic intussusception.

Résumé

Objectifs

Comme l’échographie au point de soin (POCUS) est devenue un outil précieux pour le dépistage de l’intussusception, cette étude d’amélioration de la qualité visait à mettre en œuvre une voie "POCUS-first" dans un service d’urgence pédiatrique (ED) rationaliser le flux de travail et accélérer les soins aux enfants présentant une intussusception suspectée.

Méthodes

Il s’agissait d’une analyse prospective des enfants diagnostiqués avec une intussusception iléo-colique dans un DE pédiatrique entre juin 2022 et juin 2023. L’étude a comparé la cohorte "POCUS-first" avec le groupe recevant uniquement des ultrasons radiologiques. Les principaux résultats comprenaient l’évaluation initiale par le médecin du temps de radiologie effectué aux États-Unis et l’évaluation initiale par le médecin du temps de réduction. Les efforts d’amélioration continue ont incorporé la formation, l’éducation et la diffusion des parcours des médecins en médecine d’urgence pédiatrique par le biais de cycles de plan-do-study-act.

Résultats

L’étude a inclus 29 patients dans le groupe "POCUS-first" et 70 patients dans le groupe non-POCUS. La voie "POCUS-first" a démontré une évaluation initiale significativement plus courte du temps de réduction par rapport au groupe non POCUS (170,7 minutes vs. 240,6 minutes, p = 0,02). Parmi les patients non transférés, le groupe "POCUS-first" a également eu une durée de séjour à l’urgence significativement plus courte (386 minutes vs. 544 minutes, p = 0,047).

Conclusions

La mise en œuvre d’une voie "POCUS-first" pour gérer l’intussusception iléo-colique a conduit à des améliorations notables de l’efficacité des processus. L’évaluation initiale plus courte du médecin pour réduire le temps met en évidence la possibilité d’une prise de décision et d’une intervention accélérée. Les résultats de cette étude confirment le potentiel de cette voie pour optimiser la prise en charge et les résultats des enfants atteints d’intussusception iléo-colique.

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Author notes

  1. Hadas Katz-Dana and Maya Harel-Sterling have contributed equally to this work.

Authors and Affiliations

  1. Division of Paediatric Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada

    Hadas Katz-Dana, Maya Harel-Sterling, Danielle Vincent & Lianne J. McLean

  2. Department of Pediatric Emergency Medicine, Meir Medical Center, Kfar Saba, Israel

    Hadas Katz-Dana

  3. Department of Paediatric Emergency Medicine, Children’s Health Ireland at Crumlin, Dublin, Ireland

    Danielle Vincent

  4. Department of Anesthesia, Intensive Care and Pain Medicine, Meir Medical Center, Kfar Saba, Israel

    Elad Dana

  5. Mount Sinai Hospital, Toronto, ON, Canada

    Elad Dana

  6. Department of Diagnostic and Interventional Radiology, The Hospital for Sick Children, Toronto, ON, Canada

    Oscar M. Navarro

  7. Department of Medical Imaging, University of Toronto, Toronto, ON, Canada

    Oscar M. Navarro

  8. Affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel

    Hadas Katz-Dana & Elad Dana

Authors
  1. Hadas Katz-Dana
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  2. Maya Harel-Sterling
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Corresponding author

Correspondence to Hadas Katz-Dana.

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Katz-Dana, H., Harel-Sterling, M., Vincent, D. et al. A POCUS-first pathway to streamline care for children with suspected ileocolic intussusception. Can J Emerg Med 26, 235–243 (2024). https://doi.org/10.1007/s43678-024-00673-9

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  • DOI: https://doi.org/10.1007/s43678-024-00673-9

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